Provider Demographics
NPI:1447621354
Name:POTTRATZ, TARA (RPH)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:POTTRATZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 SMELTER AVE NE
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-1940
Mailing Address - Country:US
Mailing Address - Phone:406-761-1456
Mailing Address - Fax:406-761-4536
Practice Address - Street 1:701 SMELTER AVE NE
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-1940
Practice Address - Country:US
Practice Address - Phone:406-761-1456
Practice Address - Fax:406-761-4536
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-18
Last Update Date:2015-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist