Provider Demographics
NPI:1891885364
Name:PORTER DRUG
Entity type:Organization
Organization Name:PORTER DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PORTER DRUG
Authorized Official - Prefix:MR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:806-667-3476
Mailing Address - Street 1:BOX 290
Mailing Address - Street 2:1522 MAIN
Mailing Address - City:PETERSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:79250-0290
Mailing Address - Country:US
Mailing Address - Phone:806-667-2231
Mailing Address - Fax:806-667-9401
Practice Address - Street 1:1522 MAIN
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:TX
Practice Address - Zip Code:79250
Practice Address - Country:US
Practice Address - Phone:806-667-2231
Practice Address - Fax:806-667-9401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX023503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy