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General NPI Number Information
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NPI Number | 1851012074
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Entity Type | Individual
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Provider Name | JOSHUA PORTA
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Gender | Male
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Dates
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Enumeration Date | 09/06/2022
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 4555 WISCONSIN AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20016-4619
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Country | US
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Telephone | 202-537-1587
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Fax |
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Provider Business Mailing Address
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Address Line | 1212 4TH ST SE APT 631
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City | WASHINGTON
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State | DC
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Zip | 20003-3495
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Country | US
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Telephone |
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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 | PH100003048
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License Number State | DC
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