Provider Demographics
NPI:1649459603
Name:PORTER, ANGELA GILLAND (RPH)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:GILLAND
Last Name:PORTER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:7979 WURZBACH RD
Mailing Address - Street 2:G354 MAIL CODE 8222
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4427
Mailing Address - Country:US
Mailing Address - Phone:210-450-5885
Mailing Address - Fax:210-616-5589
Practice Address - Street 1:7979 WURZBACH RD
Practice Address - Street 2:G354 MAIL CODE 8222
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4427
Practice Address - Country:US
Practice Address - Phone:210-450-5885
Practice Address - Fax:210-616-5589
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COPHA-16264183500000X
NC09236183500000X
TX457311835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology
No183500000XPharmacy Service ProvidersPharmacist