Provider Demographics
NPI:1639355290
Name:ORTEGA, HECTOR (PHARM D)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 SIERRA TRL
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-5024
Mailing Address - Country:US
Mailing Address - Phone:630-312-9419
Mailing Address - Fax:
Practice Address - Street 1:1730 SIERRA TRL
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-5024
Practice Address - Country:US
Practice Address - Phone:630-312-9419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051289279171W00000X
IL051-289279183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No171W00000XOther Service ProvidersContractor