Provider Demographics
NPI:1609156215
Name:PORTER, JOHN LESLIE (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LESLIE
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 1:10101 SYCAMORE SHOALS CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-3354
Mailing Address - Country:US
Mailing Address - Phone:502-244-1752
Mailing Address - Fax:502-244-1752
Practice Address - Street 1:990 BAXTER AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-2064
Practice Address - Country:US
Practice Address - Phone:502-585-3239
Practice Address - Fax:502-583-3162
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007624183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist