Provider Demographics
NPI:1548678311
Name:POTTER, MICHAEL GENE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GENE
Last Name:POTTER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27082 179TH ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-7191
Mailing Address - Country:US
Mailing Address - Phone:816-835-7103
Mailing Address - Fax:
Practice Address - Street 1:1920 HIGHWAY 73
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-5102
Practice Address - Country:US
Practice Address - Phone:913-367-6142
Practice Address - Fax:913-367-9698
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011023433183500000X
KS1-14941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist