Active NPI
Douglas Kenji Potter, R.PH.
- Pharmacist
- Longmont, CO
National Provider Identifier
1790085108
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 14641
- Practice address
- 1632 Hover St
Longmont, CO 80501-2441 - Phone
- (303) 776-0508
- Fax
- (303) 684-8468
- NPI assigned
- Nov 1, 2010
- Last updated
- Nov 1, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 14641 | CO | Primary |
Addresses
Primary practice location
1632 Hover St
Longmont, CO 80501-2441
Mailing address
1632 Hover St
Longmont, CO 80501-2441
Phone (303) 776-0508
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14641 | CO | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Safeway Inc | Past | Accepting new patients | |
| 1918 Winter Street Operating Co LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Safeway Pharmacy #2910
- Community/Retail Pharmacy
- Longmont, CO
- NPI 1801667837
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1288569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1288569600000",
"number": "1790085108",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1632 HOVER ST",
"city": "LONGMONT",
"state": "CO",
"postal_code": "805012441",
"telephone_number": "303-776-0508",
"fax_number": "303-684-8468"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1632 HOVER ST",
"city": "LONGMONT",
"state": "CO",
"postal_code": "805012441",
"telephone_number": "303-776-0508",
"fax_number": "303-684-8468"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTTER",
"first_name": "DOUGLAS",
"middle_name": "KENJI",
"credential": "R.PH.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-11-01",
"last_updated": "2010-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CO",
"license": "14641",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Longmont, CO
- Amanda K. Pooler, DDS
- Katherine Cashman Porter, CRNA
- Abigail Portillo, RN
- Allison Kathleen Portillo, MA
- Melanie Potock, MA, CCC-SLP
- Phillip Adam Potter, MA, BCBA
- Rachel Amelia Potter, O.D.
- Poudre Valley Medical Group, LLC (UCHealth Medical Group)
- Poudre Valley Medical Group, LLC (UCHealth Medical Group)
- Poudre Valley Medical Group, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.