| NPI | 1992735666 |
|---|---|
| Doing Business As | PORTAGE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | LAWRENCE CURTIS Vice President 269-327-0033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: IL 054.017842) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: WI 1994-43) |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: OH NRP.022791200-03) | |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: NY 035724) | |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: PA NP000798) | |
| 3336C0004X Pharmacy, Compounding Pharmacy (Licence: IN 64002337A) | |
| 333600000X Pharmacy (Licence: MI 5301002930) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2018-07-19 |