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NPI Code Detail

MEDICARE: DR. ELIZABETH MARIE PORTER PHARM.D.

MEDICARE: DR. ELIZABETH MARIE PORTER PHARM.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist12435NE

General Provider Information

NPI Number : 1104859693
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELIZABETH MARIE PORTER PHARM.D.
Provider Business Mailing Address
First Line : 104 HANKS WAY
Second Line :
City : SOUTH SIOUX CITY
State : NE
Zip : 68776-5460
Country : US
Telephone Number : 402-385-8043
Fax Number :
Provider Business Practice Location Address
First Line : 923 SENIOR CIR
Second Line :
City : MACY
State : NE
Zip : 68039-4018
Country : US
Telephone Number : 402-837-4358
Fax Number : 402-837-5381
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2006
Last Update Date : 04/10/2025

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