Healthcare Provider Details

I. General information

NPI: 1326035494
Provider Name (Legal Business Name): SCOTT ALLEN PORTER R PH PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 N 5TH AVE
SANDPOINT ID
83864-1520
US

IV. Provider business mailing address

604 N FIFTH AVE
SANDPOINT ID
83864-1520
US

V. Phone/Fax

Practice location:
  • Phone: 208-263-1408
  • Fax: 208-265-8784
Mailing address:
  • Phone: 208-263-1408
  • Fax: 208-265-8784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP5055
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: