Provider Demographics
NPI:1467271635
Name:PORTEUS, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PORTEUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5589 ROYAL DUBLIN DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-9438
Mailing Address - Country:US
Mailing Address - Phone:614-832-4829
Mailing Address - Fax:
Practice Address - Street 1:3711 RIDGE MILL DR RM 1023
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-9554
Practice Address - Country:US
Practice Address - Phone:614-366-1576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03120576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist