Provider Demographics
NPI:1558959445
Name:POTTS, DEIDRA DARLENE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEIDRA
Middle Name:DARLENE
Last Name:POTTS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N BURKHARDT RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-2727
Mailing Address - Country:US
Mailing Address - Phone:765-427-1199
Mailing Address - Fax:
Practice Address - Street 1:101 N BURKHARDT RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2727
Practice Address - Country:US
Practice Address - Phone:765-427-1199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022020A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist