Organization
POTTERS HOUSE APOTHECARY INC
Active
Other names
Potter's House Apothecary
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN BORG PHARMD (PRESIDENT/PHARMACIST)
(623) 362-9322
Entity
Organization
Contact information
Practice address
21585 N 77TH AVE, STE 1500, PEORIA, AZ 85382
(623) 362-9322
(623) 362-9001
Mailing address
21585 N 77TH AVE, STE 1500, PEORIA, AZ 85382
(623) 362-9322
(623) 362-9001
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
Y005043
AZ
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2119474
PK
—
05
—
432524
—
AZ
Enumeration date
03/18/2009
Last updated
03/14/2016
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