NPI | 1164945762 |
---|---|
Former Name | JESSICA MARIE POTTHOFF |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 183500000X Pharmacist (Licence: NE 15781) |
Additional Taxonomies | 183500000X Pharmacist (Licence: SD 6408) |
Enumeration Date | 2017-07-25 |
Last Update Date | 2018-03-17 |