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General NPI Number Information
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NPI Number | 1548645138
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Entity Type | Individual
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Provider Name | DAVID ETHAN PORTER PHARM.D
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Gender | Male
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Dates
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Enumeration Date | 07/23/2015
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Last Update Date | 01/26/2017
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Provider Practice Location Address
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Address Line | 40 VASSAR RD
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City | POUGHKEEPSIE
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State | NY
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Zip | 12603-5247
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Country | US
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Telephone | 845-462-9773
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Fax | 845-463-3926
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Provider Business Mailing Address
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Address Line | 40 VASSAR RD
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City | POUGHKEEPSIE
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State | NY
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Zip | 12603-5247
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Country | US
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Telephone | 845-462-9773
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Fax | 845-463-3926
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 060721
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License Number State | NY
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