Edwin Ray Potts, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

332B00000X Issued in IL

Practice address

1116 W Main St
Fairfield, IL 62837-2324

Phone

(618) 842-6007

Fax

(618) 842-4816

NPI assigned

May 9, 2006

Last updated

Jul 16, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216166400000",
    "number": "1396794954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1116 W MAIN ST",
            "city": "FAIRFIELD",
            "state": "IL",
            "postal_code": "628372324",
            "telephone_number": "618-842-6007",
            "fax_number": "618-842-4816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1116 W MAIN ST",
            "city": "FAIRFIELD",
            "state": "IL",
            "postal_code": "628372324",
            "telephone_number": "618-842-6007",
            "fax_number": "618-842-4816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTTS",
        "first_name": "EDWIN",
        "middle_name": "RAY",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-09",
        "last_updated": "2008-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "332B00000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "371200692001",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0009632011",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "1453531",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Penny Attaway (Medical Services Unlimited)
• Irina Podolsky
• Priscilla Poore
• Joan A Potter, CRNA
• Potts Family LLC (Potts Family Pharmacy)
• Stephen Dean Potts, PHARMD
• Deseree Daun Price
• Stacey L. Puntney, LPN
• Kathryn Marie Rawls, M.A., LCPC
• Ronnie Ray, PHARMD

• Pharmacist in Fairfield, IL
• Providers in Fairfield, IL by specialty
• Pharmacist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.