Provider Demographics
NPI:1912671215
Name:POTTER, SHELBY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W AIRPORT HWY
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:OH
Mailing Address - Zip Code:43558-1410
Mailing Address - Country:US
Mailing Address - Phone:419-825-1161
Mailing Address - Fax:419-825-1775
Practice Address - Street 1:105 W AIRPORT HWY
Practice Address - Street 2:
Practice Address - City:SWANTON
Practice Address - State:OH
Practice Address - Zip Code:43558-1410
Practice Address - Country:US
Practice Address - Phone:419-825-1161
Practice Address - Fax:419-825-1775
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03440942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist