Provider Demographics
NPI:1144982372
Name:POTESTAS, ARA (PHARM D)
Entity type:Individual
Prefix:
First Name:ARA
Middle Name:
Last Name:POTESTAS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 HAVERHILL DR APT 421
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75707-4522
Mailing Address - Country:US
Mailing Address - Phone:806-681-5665
Mailing Address - Fax:
Practice Address - Street 1:2120 E SE LOOP 323
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8318
Practice Address - Country:US
Practice Address - Phone:903-593-1507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist