Provider Demographics
NPI:1275834392
Name:PORTER, AMBER LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:LYNN
Last Name:PORTER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:LYNN
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1100 NE BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232
Mailing Address - Country:US
Mailing Address - Phone:503-528-0506
Mailing Address - Fax:503-528-0508
Practice Address - Street 1:1100 NE BROADWAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232
Practice Address - Country:US
Practice Address - Phone:503-528-0506
Practice Address - Fax:503-528-0508
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10680183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist