Provider Demographics
NPI:1194115758
Name:PORRATA, JANICE IVETTE
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:IVETTE
Last Name:PORRATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2939 W ADDISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4635
Mailing Address - Country:US
Mailing Address - Phone:773-604-7681
Mailing Address - Fax:773-250-0219
Practice Address - Street 1:2939 W ADDISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-4635
Practice Address - Country:US
Practice Address - Phone:773-604-7681
Practice Address - Fax:773-250-0219
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL049.188934183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician