Provider Demographics
NPI:1346915139
Name:PORTTEUS, ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:PORTTEUS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LIBBIE
Other - Middle Name:
Other - Last Name:PORTTEUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1823 TOWERCREST RD
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-3870
Mailing Address - Country:US
Mailing Address - Phone:574-780-0209
Mailing Address - Fax:
Practice Address - Street 1:1501 W CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-4505
Practice Address - Country:US
Practice Address - Phone:910-891-1930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist