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
—
—
3336L0003X
Long Term Care Pharmacy
—
—
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
Update your record
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