# POTTS FAMILY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Potts Family Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316681745
- **Authorized official:** DR. STEPHEN DEAN POTTS PHARMD. (OWNER)
- **Authorized official phone:** (618) 919-4009

## Contact information

- **Practice address:** 709 W MAIN ST STE A, FAIRFIELD, IL 62837-2312
- **Practice address phone:** (618) 919-4009
- **Practice address fax:** (618) 516-8988
- **Mailing address:** 709 W MAIN ST STE A, FAIRFIELD, IL 62837-2312
- **Mailing address phone:** (618) 919-4009
- **Mailing address fax:** (618) 516-8988

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 04/21/2022
- **Last updated:** 06/05/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 054022158 | BOARD OF PHARMACY | IL |
| 01 | — | 320013673 | ILBOP CS | IL |