Provider Demographics
NPI:1336548197
Name:POTTER, WILLIAM WALTER (RPH)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WALTER
Last Name:POTTER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 19TH ST
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-4107
Mailing Address - Country:US
Mailing Address - Phone:831-655-3834
Mailing Address - Fax:831-373-5384
Practice Address - Street 1:160 COUNTRY CLUB GATE CTR
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-5022
Practice Address - Country:US
Practice Address - Phone:831-373-8323
Practice Address - Fax:831-373-5384
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH28698183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist