Provider Demographics
NPI:1811517204
Name:PORTER, ALEESHA (RPH)
Entity type:Individual
Prefix:
First Name:ALEESHA
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 SE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MT
Mailing Address - Zip Code:59044-3324
Mailing Address - Country:US
Mailing Address - Phone:406-628-8746
Mailing Address - Fax:
Practice Address - Street 1:307 SE 4TH ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MT
Practice Address - Zip Code:59044-3324
Practice Address - Country:US
Practice Address - Phone:406-628-8746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-26
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-63043183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist