Provider Demographics
NPI:1205850229
Name:PORTER, JAMES J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:PORTER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 N 1200 W
Mailing Address - Street 2:INTERMOUNTAIN LAYTON PHARMACY
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041
Mailing Address - Country:US
Mailing Address - Phone:801-779-6210
Mailing Address - Fax:801-779-6208
Practice Address - Street 1:2075 N 1200 W
Practice Address - Street 2:INTERMOUNTAIN LAYTON PHARMACY
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1616
Practice Address - Country:US
Practice Address - Phone:801-779-6210
Practice Address - Fax:801-779-6208
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4910412-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4910412-1701OtherPHARMACIST LICENSE