Healthcare Provider Details

I. General information

NPI: 1467675108
Provider Name (Legal Business Name): ADAM DAVID PORATH PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 MILL STREET
RENO NV
89502
US

IV. Provider business mailing address

3160 ERIN DR
SPARKS NV
89436-5639
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-4266
  • Fax:
Mailing address:
  • Phone: 775-425-5762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number16909
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number16909
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16909
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: