Provider Demographics
NPI:1306043187
Name:ORTIZ, JOSE A (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:F39 COLINA DEL TOA
Mailing Address - Street 2:VILLA LAS COLINAS
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4940
Mailing Address - Country:US
Mailing Address - Phone:787-637-5131
Mailing Address - Fax:
Practice Address - Street 1:F39 COLINA DEL TOA
Practice Address - Street 2:VILLA LAS COLINAS
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4940
Practice Address - Country:US
Practice Address - Phone:787-637-5131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR42231835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6453930001Medicare NSC