Provider Demographics
NPI:1700189800
Name:POTROUS, GEHAN JM (RPH)
Entity Type:Individual
Prefix:MRS
First Name:GEHAN
Middle Name:JM
Last Name:POTROUS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7761 LIBERTY DR
Mailing Address - Street 2:#C
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7704
Mailing Address - Country:US
Mailing Address - Phone:626-392-0401
Mailing Address - Fax:
Practice Address - Street 1:7761 LIBERTY DR
Practice Address - Street 2:#C
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7704
Practice Address - Country:US
Practice Address - Phone:626-392-0401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH62164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist