Provider Demographics
NPI:1942449087
Name:PORTER, RENITA (RPH)
Entity Type:Individual
Prefix:
First Name:RENITA
Middle Name:
Last Name:PORTER
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 1:255 PHILLIPI RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1307
Mailing Address - Country:US
Mailing Address - Phone:614-296-8269
Mailing Address - Fax:614-501-0339
Practice Address - Street 1:255 PHILLIPI RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1307
Practice Address - Country:US
Practice Address - Phone:614-296-8269
Practice Address - Fax:614-501-0339
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03221391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist