Provider Demographics
NPI:1518188184
Name:PORTER, THEODORE WILLIAM (RPH)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:WILLIAM
Last Name:PORTER
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 1:4404 W SEVILLA ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629
Mailing Address - Country:US
Mailing Address - Phone:813-837-9799
Mailing Address - Fax:
Practice Address - Street 1:3000 E FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:LA
Practice Address - Zip Code:33613
Practice Address - Country:US
Practice Address - Phone:813-972-3774
Practice Address - Fax:813-971-8007
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26975183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist