Provider Demographics
NPI:1619264728
Name:POTTER, GARRY BRANDON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GARRY
Middle Name:BRANDON
Last Name:POTTER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1172 GATH LUCKY RD
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-4451
Mailing Address - Country:US
Mailing Address - Phone:931-934-3491
Mailing Address - Fax:
Practice Address - Street 1:1210 SMITHVILLE HWY
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-4451
Practice Address - Country:US
Practice Address - Phone:931-934-3491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-09
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10753183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist