Provider Demographics
NPI:1043623093
Name:POTMESIL, JERRY EDWARD I (RPH)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:EDWARD
Last Name:POTMESIL
Suffix:I
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2895 N MCCARRAN BLVD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-1882
Mailing Address - Country:US
Mailing Address - Phone:775-353-8818
Mailing Address - Fax:775-353-8821
Practice Address - Street 1:2895 N MCCARRAN BLVD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-1882
Practice Address - Country:US
Practice Address - Phone:775-353-8818
Practice Address - Fax:775-353-8821
Is Sole Proprietor?:No
Enumeration Date:2014-06-07
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV05137183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist