Provider Demographics
NPI:1508180951
Name:ORTIZ PHARMACY INC
Entity Type:Organization
Organization Name:ORTIZ PHARMACY INC
Other - Org Name:ORTIZ PHARMACY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF PHARMACY/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:210-432-2361
Mailing Address - Street 1:2515 CASTROVILLE RD
Mailing Address - Street 2:STE 107
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78237-3359
Mailing Address - Country:US
Mailing Address - Phone:210-432-2361
Mailing Address - Fax:210-434-0907
Practice Address - Street 1:2515 CASTROVILLE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78237-3359
Practice Address - Country:US
Practice Address - Phone:210-432-2361
Practice Address - Fax:210-434-0907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX267953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146132Medicaid
4555073OtherNCPDP PROVIDER IDENTIFICATION NUMBER
4842350001Medicare NSC