| 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 |