Provider Demographics
NPI:1083132138
Name:PORTERA, WILLIAM PLEASANT (RPH)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PLEASANT
Last Name:PORTERA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-7547
Mailing Address - Country:US
Mailing Address - Phone:662-418-1200
Mailing Address - Fax:
Practice Address - Street 1:223 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-3358
Practice Address - Country:US
Practice Address - Phone:662-324-7112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2017-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-05812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist