Healthcare Provider Details

I. General information

NPI: 1427649359
Provider Name (Legal Business Name): ROBERT DUANE PORTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 STATE HIGHWAY 319
BELFRY KY
41514-8678
US

IV. Provider business mailing address

PO BOX 245
BELFRY KY
41514-0245
US

V. Phone/Fax

Practice location:
  • Phone: 606-237-0555
  • Fax: 606-237-1069
Mailing address:
  • Phone: 606-237-0555
  • Fax: 606-237-1069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number010650
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: