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Individual

MR. EDWIN RAY POTTS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RPH

Contact information

Practice address
1116 W MAIN ST, FAIRFIELD, IL 62837-2324
(618) 842-6007
(618) 842-4816
Mailing address
1116 W MAIN ST, FAIRFIELD, IL 62837-2324
(618) 842-6007
(618) 842-4816

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
332B00000X
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0009632011
BLUE CROSS BLUE SHIELD
IL
01
1453531
NABP
IL
05
371200692001
IL
Enumeration date
05/09/2006
Last updated
07/16/2008
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