Provider Demographics
NPI:1720688328
Name:PORTER, KRISTIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:734 CARMA WAY
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-2006
Mailing Address - Country:US
Mailing Address - Phone:435-590-8249
Mailing Address - Fax:
Practice Address - Street 1:625 W TELEGRAPH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780-1541
Practice Address - Country:US
Practice Address - Phone:435-628-5424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5641459-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist