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General NPI Number Information
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NPI Number | 1992142640
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Entity Type | Individual
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Provider Name | JOHNNY LYNN PORTER PD (PHARMACIST)
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Gender | Male
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Dates
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Enumeration Date | 06/03/2013
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Last Update Date | 06/03/2013
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Provider Practice Location Address
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Address Line | 826 N SEBASTIAN
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City | WEST HELENA
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State | AR
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Zip | 72390-1821
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Country | US
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Telephone | 870-572-3996
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 100
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City | ROE
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State | AR
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Zip | 72134-0100
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Country | US
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Telephone | 870-241-3858
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Fax |
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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 | PD06940
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License Number State | AR
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