Provider Demographics
NPI:1083316855
Name:RENOWN SOUTH MEADOWS MEDICAL CENTER
Entity Type:Organization
Organization Name:RENOWN SOUTH MEADOWS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PORATH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:775-982-6838
Mailing Address - Street 1:1155 MILL ST # U12
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-6838
Mailing Address - Fax:775-982-5110
Practice Address - Street 1:10101 DOUBLE R BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-3149
Practice Address - Country:US
Practice Address - Phone:775-982-5364
Practice Address - Fax:775-982-5110
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENOWN SOUTH MEADOWS MEDICAL CENTET
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy