Provider Demographics
NPI:1073099958
Name:PORINCHAK, ERIC WILLIAM
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:WILLIAM
Last Name:PORINCHAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9714 DELTONA DR
Mailing Address - Street 2:
Mailing Address - City:NEW MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44442-9718
Mailing Address - Country:US
Mailing Address - Phone:330-718-3742
Mailing Address - Fax:
Practice Address - Street 1:307 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4702
Practice Address - Country:US
Practice Address - Phone:330-758-2824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03337713183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist