Provider Demographics
NPI:1336448075
Name:PORTEOUS, BARBARA W
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:W
Last Name:PORTEOUS
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 1:417 BOONES CREEK RD
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-5165
Mailing Address - Country:US
Mailing Address - Phone:423-753-9701
Mailing Address - Fax:432-753-7891
Practice Address - Street 1:417 BOONES CREEK RD
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-5165
Practice Address - Country:US
Practice Address - Phone:423-753-9701
Practice Address - Fax:432-753-7891
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist