Provider Demographics
NPI:1104080498
Name:PORTMAN, SCOTT B (R PH)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:B
Last Name:PORTMAN
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9595 COLLINS AVE APT 509
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2636
Mailing Address - Country:US
Mailing Address - Phone:305-778-4844
Mailing Address - Fax:954-570-8491
Practice Address - Street 1:9595 COLLINS AVE APT 509
Practice Address - Street 2:
Practice Address - City:SURFSIDE
Practice Address - State:FL
Practice Address - Zip Code:33154-2636
Practice Address - Country:US
Practice Address - Phone:305-778-4844
Practice Address - Fax:954-570-8491
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0021432183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist