Provider Demographics
NPI:1326035494
Name:PORTER, SCOTT ALLEN (R PH PHARM D)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ALLEN
Last Name:PORTER
Suffix:
Gender:M
Credentials:R PH PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 N FIFTH AVE
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1520
Mailing Address - Country:US
Mailing Address - Phone:208-263-1408
Mailing Address - Fax:208-265-8784
Practice Address - Street 1:604 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1520
Practice Address - Country:US
Practice Address - Phone:208-263-1408
Practice Address - Fax:208-265-8784
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5055183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist