Provider Demographics
NPI:1194800326
Name:RENOWN REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:RENOWN REGIONAL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PORATH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, BCACP, BCPS-
Authorized Official - Phone:775-982-6838
Mailing Address - Street 1:21 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1316
Mailing Address - Country:US
Mailing Address - Phone:775-982-5281
Mailing Address - Fax:775-982-5250
Practice Address - Street 1:21 LOCUST ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1316
Practice Address - Country:US
Practice Address - Phone:775-982-5281
Practice Address - Fax:775-982-5250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
NVPH008393336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2056839OtherPK
NV2816185Medicaid