Provider Demographics
NPI:1528949997
Name:PORTERVILLE PHARMACY INC
Entity type:Organization
Organization Name:PORTERVILLE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ADLY
Authorized Official - Last Name:MIKHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-615-1560
Mailing Address - Street 1:1270 W HENDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-1455
Mailing Address - Country:US
Mailing Address - Phone:559-615-1560
Mailing Address - Fax:559-615-1670
Practice Address - Street 1:1270 W HENDERSON AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-1455
Practice Address - Country:US
Practice Address - Phone:559-615-1560
Practice Address - Fax:559-615-1570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy