Provider Demographics
NPI:1427649359
Name:PORTER, ROBERT DUANE
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DUANE
Last Name:PORTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:BELFRY
Mailing Address - State:KY
Mailing Address - Zip Code:41514-0245
Mailing Address - Country:US
Mailing Address - Phone:606-237-0555
Mailing Address - Fax:606-237-1069
Practice Address - Street 1:20 STATE HIGHWAY 319
Practice Address - Street 2:
Practice Address - City:BELFRY
Practice Address - State:KY
Practice Address - Zip Code:41514-8678
Practice Address - Country:US
Practice Address - Phone:606-237-0555
Practice Address - Fax:606-237-1069
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010650183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist