Provider Demographics
NPI:1598076333
Name:ORTIZ, THERESA VILLARREAL (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:VILLARREAL
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 BRAZOS ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-7408
Mailing Address - Country:US
Mailing Address - Phone:361-218-9315
Mailing Address - Fax:
Practice Address - Street 1:701 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1553
Practice Address - Country:US
Practice Address - Phone:956-683-9392
Practice Address - Fax:956-618-5765
Is Sole Proprietor?:No
Enumeration Date:2010-06-26
Last Update Date:2010-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist