Active NPI
Jeff Porter, RPH
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Southaven, MS
National Provider Identifier
1881282358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- E-08671
- Practice address
- 3095 Goodman Rd E
Southaven, MS 38672-8707 - Phone
- (662) 536-3743
- NPI assigned
- Jan 9, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | E-08671 | MS | Primary |
Addresses
Primary practice location
3095 Goodman Rd E
Southaven, MS 38672-8707
Mailing address
1706 Montys Cir N
Southaven, MS 38672-9122
Phone (901) 288-9270
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E-08671 | MS | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kroger Limited Partnership I | Current | Accepting new patients | |
| Kroger Limited Partnership I | Past | Accepting new patients |
Locations
3095 Goodman Rd E
Southaven, MS 38672
Phone (662) 536-3743
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Southaven, MS
- NPI 1386678167
-
- Community/Retail Pharmacy
- Newport, KY
- NPI 1104791078
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610150400000",
"number": "1881282358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1706 MONTYS CIR N",
"city": "SOUTHAVEN",
"state": "MS",
"postal_code": "386729122",
"telephone_number": "901-288-9270"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3095 GOODMAN RD E",
"city": "SOUTHAVEN",
"state": "MS",
"postal_code": "386728707",
"telephone_number": "662-536-3743"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTER",
"first_name": "JEFF",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-01-09",
"last_updated": "2021-01-09",
"certification_date": "2021-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "MS",
"license": "E-08671",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Southaven, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.