Provider Demographics
NPI:1073106084
Name:DUNAWAY, PORTIA ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:PORTIA
Middle Name:ANN
Last Name:DUNAWAY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 HIGHWAY 15 S STE 2
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-7370
Mailing Address - Country:US
Mailing Address - Phone:606-666-5519
Mailing Address - Fax:606-666-9371
Practice Address - Street 1:265 HIGHWAY 15 S STE 2
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339-7370
Practice Address - Country:US
Practice Address - Phone:606-666-5519
Practice Address - Fax:606-666-9371
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10620183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist