Provider Demographics
NPI:1871195347
Name:RENOWN REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:RENOWN REGIONAL MEDICAL CENTER
Other - Org Name:RENOWN SPECIALTY PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:VP, PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PORATH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, BCACP, BCPS-
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:
Practice Address - Street 1:21 LOCUST ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1316
Practice Address - Country:US
Practice Address - Phone:775-982-5280
Practice Address - Fax:775-982-5250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-10
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy