Provider Demographics
NPI:1609993815
Name:PORTER, HOMER EDWIN JR (BPHARM)
Entity type:Individual
Prefix:MR
First Name:HOMER
Middle Name:EDWIN
Last Name:PORTER
Suffix:JR
Gender:M
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-1445
Mailing Address - Country:US
Mailing Address - Phone:626-794-8965
Mailing Address - Fax:626-794-9081
Practice Address - Street 1:1870 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-1445
Practice Address - Country:US
Practice Address - Phone:626-794-8965
Practice Address - Fax:626-794-9081
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 35059183500000X
WI8592-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist