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NPI Code Detail

MEDICARE: NICHOLAS BYAM PORTER PHARMD

MEDICARE: NICHOLAS BYAM PORTER PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistS016675AZ

General Provider Information

NPI Number : 1467782631
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS BYAM PORTER PHARMD
Provider Business Mailing Address
First Line : 2929 W VALENCIA RD
Second Line :
City : TUCSON
State : AZ
Zip : 85746-8036
Country : US
Telephone Number : 520-578-0138
Fax Number :
Provider Business Practice Location Address
First Line : 2929 W VALENCIA RD
Second Line :
City : TUCSON
State : AZ
Zip : 85746-8036
Country : US
Telephone Number : 520-578-0138
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2010
Last Update Date : 01/11/2010

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Directions to “ NICHOLAS BYAM PORTER PHARMD” Practice Location

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