Provider Demographics
NPI:1740009075
Name:PORTNOY, SOPHIE LYNN (RPH)
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:LYNN
Last Name:PORTNOY
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 1:113 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2431
Mailing Address - Country:US
Mailing Address - Phone:201-663-1351
Mailing Address - Fax:
Practice Address - Street 1:2441 VESTAL PKWY E
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2001
Practice Address - Country:US
Practice Address - Phone:607-797-1370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072059183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist