Provider Demographics
NPI:1013129121
Name:PORTELLA, STEFANIE (RPH)
Entity Type:Individual
Prefix:MS
First Name:STEFANIE
Middle Name:
Last Name:PORTELLA
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 1:16027 89TH ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3410
Mailing Address - Country:US
Mailing Address - Phone:718-843-7458
Mailing Address - Fax:
Practice Address - Street 1:2758 GERRITSEN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-5915
Practice Address - Country:US
Practice Address - Phone:718-332-7155
Practice Address - Fax:718-648-5482
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist