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General NPI Number Information
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NPI Number | 1184083644
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Entity Type | Organization
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Legal Business Name | PORTERVILLE PHARMACY INC
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Dates
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Enumeration Date | 02/12/2016
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Last Update Date | 04/09/2019
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Provider Practice Location Address
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Address Line | 406 W PUTNAM AVE
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City | PORTERVILLE
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State | CA
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Zip | 93257-3321
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Country | US
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Telephone | 559-793-4410
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Fax |
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Provider Business Mailing Address
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Address Line | 406 W PUTNAM AVE
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City | PORTERVILLE
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State | CA
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Zip | 93257-3321
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Country | US
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Telephone | 559-306-0404
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Fax |
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Authorized Official
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Title or Position | OWNER / PIC
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Name | JOHN MIKHAEL
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Credential |
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Telephone | 559-793-4410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY53909
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License Number State | CA
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