Provider Demographics
NPI:1629452792
Name:PORTER, TAYLOR ANNE
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ANNE
Last Name:PORTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 S KERR AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1416
Mailing Address - Country:US
Mailing Address - Phone:910-799-0830
Mailing Address - Fax:910-799-7952
Practice Address - Street 1:23 S KERR AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1416
Practice Address - Country:US
Practice Address - Phone:910-799-0830
Practice Address - Fax:910-799-7952
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25353183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist