Provider Demographics
NPI:1528599446
Name:ORTIZ, JIMMY (PHARMD)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14188 SW 145TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6786
Mailing Address - Country:US
Mailing Address - Phone:786-282-8124
Mailing Address - Fax:
Practice Address - Street 1:9105 S DADELAND BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7813
Practice Address - Country:US
Practice Address - Phone:305-670-8929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL55499183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist