Healthcare Provider Details

I. General information

NPI: 1790295590
Provider Name (Legal Business Name): LASHION PORTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 10/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 N MAIN ST
SUFFOLK VA
23434-4426
US

IV. Provider business mailing address

1113 AUBURN LN
HAMPTON VA
23666-2437
US

V. Phone/Fax

Practice location:
  • Phone: 757-539-9992
  • Fax:
Mailing address:
  • Phone: 757-372-5926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202216277
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: