Provider Demographics
NPI:1265765002
Name:POTTS, ALAN (PHARMD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:POTTS
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 1:1096 S SAINT FRANCIS DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-1654
Mailing Address - Country:US
Mailing Address - Phone:505-982-9811
Mailing Address - Fax:505-982-1072
Practice Address - Street 1:1096 S SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-1654
Practice Address - Country:US
Practice Address - Phone:505-982-9811
Practice Address - Fax:505-982-1072
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist