Individual
JORDAN PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
10500 W OVERLAND RD, BOISE, ID 83709-1435
(208) 376-1382
Mailing address
3080 W CEDAR GROVE ST, MERIDIAN, ID 83646-2909
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P7032
ID
Other
Enumeration date
09/12/2014
Last updated
09/12/2014
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