Provider Demographics
NPI:1760779961
Name:POTTER, LINDA LUCILLE (RPH)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:LUCILLE
Last Name:POTTER
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 1:7701 9TH ST N
Mailing Address - Street 2:T-1131
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-1102
Mailing Address - Country:US
Mailing Address - Phone:727-576-3826
Mailing Address - Fax:727-576-3826
Practice Address - Street 1:8151 MARTIN LUTHER KING ST N
Practice Address - Street 2:T-1131
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4111
Practice Address - Country:US
Practice Address - Phone:727-576-3826
Practice Address - Fax:727-576-3826
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39372183500000X
MN111481183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist