Healthcare Provider Details

I. General information

NPI: 1003536806
Provider Name (Legal Business Name): ALEXANDRA PORTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 BEGLIS PKWY
SULPHUR LA
70663-5603
US

IV. Provider business mailing address

4550 BROOKLYN DR
SULPHUR LA
70665-9380
US

V. Phone/Fax

Practice location:
  • Phone: 337-528-9918
  • Fax:
Mailing address:
  • Phone: 337-532-2587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number024500
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.024500
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: