Provider Demographics
NPI:1467782631
Name:PORTER, NICHOLAS BYAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:BYAM
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 1:2929 W VALENCIA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-8036
Mailing Address - Country:US
Mailing Address - Phone:520-578-0138
Mailing Address - Fax:
Practice Address - Street 1:2929 W VALENCIA RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-8036
Practice Address - Country:US
Practice Address - Phone:520-578-0138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016675183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist