Provider Demographics
NPI:1659619906
Name:GIFFORD, PORTIA NEKIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PORTIA
Middle Name:NEKIA
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 TAYLORSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-3530
Mailing Address - Country:US
Mailing Address - Phone:502-493-2732
Mailing Address - Fax:
Practice Address - Street 1:4640 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-3530
Practice Address - Country:US
Practice Address - Phone:502-493-2732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024823A183500000X
KY016240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist