Provider Demographics
NPI:1548869688
Name:POTTER, JEFFERY TAYLOR II (PHARMD)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:TAYLOR
Last Name:POTTER
Suffix:II
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 1:3220 SAINT ANN ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-7059
Mailing Address - Country:US
Mailing Address - Phone:270-922-0395
Mailing Address - Fax:
Practice Address - Street 1:2308 HIGHWAY 144
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-0175
Practice Address - Country:US
Practice Address - Phone:270-926-7751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0513022861835P0018X
KY0202101835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist