Provider Demographics
NPI:1093149544
Name:ORTIZ, TRAVIS HECTOR (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:HECTOR
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 W 25TH AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-1629
Mailing Address - Country:US
Mailing Address - Phone:907-317-7089
Mailing Address - Fax:
Practice Address - Street 1:1429 W 25TH AVE
Practice Address - Street 2:UNIT A
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-1629
Practice Address - Country:US
Practice Address - Phone:907-317-7089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-01
Last Update Date:2013-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3884183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician