Provider Demographics
NPI:1619290087
Name:PORCO, GEORGE JOSEPH (RPH)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:JOSEPH
Last Name:PORCO
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 1:101 FEDERAL RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-4019
Mailing Address - Country:US
Mailing Address - Phone:203-798-7753
Mailing Address - Fax:203-798-7782
Practice Address - Street 1:101 FEDERAL RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-4019
Practice Address - Country:US
Practice Address - Phone:203-798-7753
Practice Address - Fax:203-798-7782
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist