Provider Demographics
NPI:1568746527
Name:POTRZEBA, JOSHUA RYAN (PHARMD, BCGP)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:RYAN
Last Name:POTRZEBA
Suffix:
Gender:M
Credentials:PHARMD, BCGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 S LAKE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-8230
Mailing Address - Country:US
Mailing Address - Phone:801-982-4733
Mailing Address - Fax:
Practice Address - Street 1:2525 S LAKE PARK BLVD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-8230
Practice Address - Country:US
Practice Address - Phone:801-982-4733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10628594-17011835G0303X
VA0202210735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No183500000XPharmacy Service ProvidersPharmacist