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General NPI Number Information
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NPI Number | 1497005110
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Entity Type | Individual
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Provider Name | AMY DIANE PORTER PHARM D
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Gender | Female
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Dates
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Enumeration Date | 09/11/2012
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 1550 SW 27TH ST
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City | EL RENO
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State | OK
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Zip | 73036-5852
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Country | US
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Telephone | 405-262-0293
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Fax |
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Provider Business Mailing Address
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Address Line | 5466 15TH ST SW
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City | EL RENO
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State | OK
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Zip | 73036-8883
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Country | US
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Telephone | 806-676-2031
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 13644
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License Number State | OK
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