Active NPI
Portia W Licht, R PH
- Pharmacist
- Waverly, IA
National Provider Identifier
1306283734
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 13316
- Practice address
- 920 Bremer Rd
Waverly, IA 50677-4141 - Phone
- (319) 352-4756
- NPI assigned
- May 24, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 13316 | IA | Primary |
Addresses
Primary practice location
920 Bremer Rd
Waverly, IA 50677-4141
Mailing address
920 Bremer Rd
Waverly, IA 50677-4141
Phone (319) 352-4756
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13316 | IA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369353600000",
"number": "1306283734",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "920 BREMER RD",
"city": "WAVERLY",
"state": "IA",
"postal_code": "506774141",
"telephone_number": "319-352-4756"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "920 BREMER RD",
"city": "WAVERLY",
"state": "IA",
"postal_code": "506774141",
"telephone_number": "319-352-4756"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICHT",
"first_name": "PORTIA",
"middle_name": "W",
"credential": "R PH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-05-24",
"last_updated": "2013-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IA",
"license": "13316",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waverly, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.