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General NPI Number Information
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NPI Number | 1891885364
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Entity Type | Organization
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Legal Business Name | PORTER DRUG
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 07/03/2008
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Provider Practice Location Address
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Address Line | 1522 MAIN
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City | PETERSBURG
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State | TX
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Zip | 79250
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Country | US
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Telephone | 806-667-2231
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Fax | 806-667-9401
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Provider Business Mailing Address
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Address Line | BOX 290 1522 MAIN
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City | PETERSBURG
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State | TX
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Zip | 79250-0290
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Country | US
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Telephone | 806-667-2231
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Fax | 806-667-9401
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Authorized Official
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Title or Position | OWNER PORTER DRUG
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Name | MR. KIM MARK PORTER
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Credential | RPH
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Telephone | 806-667-3476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 02350
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License Number State | TX
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