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Organization
POTTS FAMILY LLC
Active
Organization
POTTS FAMILY LLC
Active
Other names
Potts Family Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN DEAN POTTS PHARMD. (OWNER)
(618) 919-4009
Entity
Organization
Contact information
Practice address
709 W MAIN ST STE A, FAIRFIELD, IL 62837-2312
(618) 919-4009
(618) 516-8988
Mailing address
709 W MAIN ST STE A, FAIRFIELD, IL 62837-2312
(618) 919-4009
(618) 516-8988
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
3336L0003X
Long Term Care Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054022158
BOARD OF PHARMACY
IL
01
—
320013673
ILBOP CS
IL
Enumeration date
04/21/2022
Last updated
06/05/2024
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