Healthcare Provider Details

I. General information

NPI: 1609704360
Provider Name (Legal Business Name): RENOWN REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 MAESTRO DR STE 100
RENO NV
89511-2207
US

IV. Provider business mailing address

640 MAESTRO DR STE 100
RENO NV
89511-2207
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-5280
  • Fax: 775-982-5250
Mailing address:
  • Phone: 775-982-5280
  • Fax: 775-982-5250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: ADAM DAVID PORATH
Title or Position: VP PHARMACY SERVICES
Credential: PHARMD
Phone: 775-982-6838