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NPI Code Detail

MEDICARE: DR. KRISTIN PORTER PHARM.D.

MEDICARE: DR. KRISTIN 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
1183500000XPharmacist5641459-1701UT

General Provider Information

NPI Number : 1720688328
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISTIN PORTER PHARM.D.
Provider Business Mailing Address
First Line : 734 CARMA WAY
Second Line :
City : WASHINGTON
State : UT
Zip : 84780-2006
Country : US
Telephone Number : 435-590-8249
Fax Number :
Provider Business Practice Location Address
First Line : 625 W TELEGRAPH ST
Second Line :
City : WASHINGTON
State : UT
Zip : 84780-1541
Country : US
Telephone Number : 435-628-5424
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2020
Last Update Date : 11/01/2020

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