Provider Demographics
NPI:1710581087
Name:ORTEGA, ELIZABETH DANIELA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:DANIELA
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:DANIELA
Other - Last Name:WELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:8599 OLENCREST DR
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-8872
Mailing Address - Country:US
Mailing Address - Phone:708-612-5656
Mailing Address - Fax:
Practice Address - Street 1:214 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-9059
Practice Address - Country:US
Practice Address - Phone:740-852-5644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-26
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051298167183500000X
OH03438873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist