Active NPI
Allen Wayne Porter
- Pharmacotherapy Pharmacist
- W. St. Paul, MN
National Provider Identifier
1942351093
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacotherapy Pharmacist
- License
- 112856
- Practice address
- 2001 Robert St S
C/O Cub Pharmacy
W St Paul, MN 55118-3924 - Phone
- (651) 451-1113
- Fax
- (651) 451-9109
- NPI assigned
- Jan 16, 2007
- Last updated
- Aug 30, 2007
- 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 |
|---|---|---|---|---|
| Pharmacotherapy Pharmacist | 1835P1200X | 112856 | MN | Primary |
Addresses
Primary practice location
2001 Robert St S
C/O Cub Pharmacy
W St Paul, MN 55118-3924
Mailing address
2001 Robert St S
C/O Cub Pharmacy
W St Paul, MN 55118-3924
Phone (651) 451-1113
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 112856 | MN | MD | Pharmacotherapy Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Supervalu Pharmacies Inc. | Past | Accepting new patients | |
| Supervalu Pharmacies Inc | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1188432000000",
"number": "1942351093",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2001 ROBERT ST S",
"address_2": "C/O CUB PHARMACY",
"city": "W ST PAUL",
"state": "MN",
"postal_code": "551183924",
"telephone_number": "651-451-1113",
"fax_number": "651-451-9109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2001 ROBERT ST S",
"address_2": "C/O CUB PHARMACY",
"city": "W ST PAUL",
"state": "MN",
"postal_code": "551183924",
"telephone_number": "651-451-1113",
"fax_number": "651-451-9109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTER",
"first_name": "ALLEN",
"middle_name": "WAYNE",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-16",
"last_updated": "2007-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "1835P1200X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacotherapy",
"state": "MN",
"license": "112856",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in W. St. Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.