Healthcare Provider Details

I. General information

NPI: 1609829043
Provider Name (Legal Business Name): ANGELA K PORTER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 TUNNEL RD DEPT 119
ASHEVILLE NC
28805-2043
US

IV. Provider business mailing address

147 STONECREST DR
ASHEVILLE NC
28803-8514
US

V. Phone/Fax

Practice location:
  • Phone: 828-298-7911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15020
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: