MR. EDWIN RAY POTTS (NPI# 1396794954) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396794954 |
| Entity Type | Individual |
| Full Name | MR. EDWIN RAY POTTS |
| Credential | RPH |
| Practice Address |
1116 W Main St Fairfield IL 62837-2324 |
| Practice Telephone | 6188426007 |
| Practice Fax Number | 6188424816 |
| Mailing Telephone | 6188426007 |
| Mailing Fax Number | 6188424816 |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2008-07-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 332B00000X | IL | Pharmacy Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 371200692001 | 05 | |
| IL | BLUE CROSS BLUE SHIELD | 0009632011 | 01 |
| IL | NABP | 1453531 | 01 |
| Street Address |
1116 W MAIN ST |
| City | FAIRFIELD |
| State | IL |
| Zip Code | 62837-2324 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407485915 | Stephen Dean Potts | Pharmacist | 1116 W Main St, Fairfield, IL 62837-2324 | 2020-04-06 |
| 1700321288 | Sesser Pharmacy Si LLC | Pharmacy | 1116 W Main St, Fairfield, IL 62837-2324 | 2016-12-20 |
| 1720231608 | The Medicine Shoppe | Durable Medical Equipment & Medical Supplies | 1116 W Main St, Fairfield, IL 62837-2324 | 2008-10-23 |
| 1720172133 | Edlucy Inc | Pharmacy | 1116 W Main St, Fairfield, IL 62837-2324 | 2006-10-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881294619 | Katelyn Atteberry | Pharmacist | 150 Commerce Drive, Fairfield, IL 62837 | 2020-10-30 |
| 1265894521 | Rebecca August | Social Worker | 506 Nw 9th St, Fairfield, IL 62837 | 2016-03-25 |
| 1063814259 | Kathie L Hill | Social Worker | 303 Nw 11th St., Fairfield Memorial Hospital, Fairfield, IL 62837 | 2014-09-19 |
| 1912206731 | Way-fair Nursing and Rehabilitation Center, LLC | Skilled Nursing Facility | 305 Northwest 11th Street, Fairfield, IL 62837 | 2011-03-18 |
| 1063600773 | Alvin Ewing | Counselor | 407 N. Basin Road, Fairfield, IL 62837 | 2007-10-09 |
| 1417145129 | Gilbert Tennyson | Counselor | 407 North Basin Rd, Fairfield, IL 62837 | 2007-10-09 |
| 1972791689 | Clint Harvey | Counselor | 407 North Basin Road, Fairfield, IL 62837 | 2007-10-09 |
| 1770789778 | Fairfield Estates, LLC | Point of Service | 315 North Market Street, Fairfield, IL 62837 | 2007-06-26 |
| 1346382207 | Robert E Lowry | Counselor | 407 N Basin Rd., Fairfield, IL 62837 | 2007-02-13 |
| 1790840825 | Bradley D Kramer | Dentist | 301 Nw 11th Street, Suite 212, Fairfield, IL 62837 | 2006-12-27 |
| Find all providers in zip 62837 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881294619 | Katelyn Atteberry | Pharmacist | 150 Commerce Drive, Fairfield, IL 62837 | 2020-10-30 |
| 1033724026 | Ami Patel | Pharmacist | 695 Us Highway 46 Ste 100, Fairfield, NJ 07004-1561 | 2020-09-15 |
| 1205456662 | Joanna Pak | Pharmacist | 180 Passaic Ave Bldg B, Fairfield, NJ 07004-3516 | 2020-04-25 |
| 1033758420 | Jenny Treece | Pharmacist | 367 Dave Creek Parkway, Fairfield, AR 72088-1223 | 2020-01-02 |
| 1043861941 | Neil H Sandow | Pharmacist | 1330 Gateway Blvd, Fairfield, CA 94533-6915 | 2019-09-23 |
| 1245737378 | Xiao Peng Zhao | Pharmacist | 4950 Fulton Dr Ste 1a, Fairfield, CA 94534-1615 | 2018-04-05 |
| 1427577386 | Melisa Kelley | Pharmacist | 480 Chadbourne Rd Ste 101, Fairfield, CA 94534-9641 | 2017-09-12 |
| 1972034817 | Victoria Wong-chiu | Pharmacist | 5088 Bianco Cir, Fairfield, CA 94534-4132 | 2017-03-22 |
| 1932630852 | Jaqueline Araujo | Pharmacist | 1000 Nightingale Dr, Fairfield, CA 94533-2329 | 2017-03-22 |
| 1154852291 | Krystal Garcia | Pharmacist | 2108 Arabian Dr, Fairfield, CA 94534-7442 | 2017-03-21 |
| Find all providers in FAIRFIELD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.