Provider Demographics
NPI:1770865818
Name:POTTER, MELANIE K (RPH)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:K
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 1:4 WOBURN ABBEY DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6234
Mailing Address - Country:US
Mailing Address - Phone:603-488-5307
Mailing Address - Fax:
Practice Address - Street 1:227 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-4838
Practice Address - Country:US
Practice Address - Phone:603-666-8538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR1950183500000X
MAPH24680183500000X
FLPS35351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist