Provider Demographics
NPI:1508875626
Name:POTTS, LISA ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:POTTS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:LOOMIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5455 N MARGINAL RD APT 304
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-3942
Mailing Address - Country:US
Mailing Address - Phone:231-557-0586
Mailing Address - Fax:216-445-6377
Practice Address - Street 1:9500 EUCLID AVE # W20
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-4406
Practice Address - Fax:216-445-6377
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH031275311835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy