Provider Demographics
NPI:1043532641
Name:PORTER, TIFFANY C (RPH)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:C
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 1:1021 S PENDLETON ST
Mailing Address - Street 2:BILO PHARMACY #283
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-1045
Mailing Address - Country:US
Mailing Address - Phone:864-306-1539
Mailing Address - Fax:864-859-7882
Practice Address - Street 1:1021 S PENDLETON ST
Practice Address - Street 2:BILO PHARMACY #283
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-1045
Practice Address - Country:US
Practice Address - Phone:864-306-1539
Practice Address - Fax:864-859-7882
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist