Healthcare Provider Details

I. General information

NPI: 1528530367
Provider Name (Legal Business Name): COURTNEY PORTER RCPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 HALL RD
SEAGOVILLE TX
75159-2916
US

IV. Provider business mailing address

112 HALL RD
SEAGOVILLE TX
75159-2916
US

V. Phone/Fax

Practice location:
  • Phone: 972-287-7070
  • Fax: 972-287-8199
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number255606
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: