Provider Demographics
NPI:1497005110
Name:PORTER, AMY DIANE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:DIANE
Last Name:PORTER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5466 15TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-8883
Mailing Address - Country:US
Mailing Address - Phone:806-676-2031
Mailing Address - Fax:
Practice Address - Street 1:1550 SW 27TH ST
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-5852
Practice Address - Country:US
Practice Address - Phone:405-262-0293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist