Provider Demographics
NPI:1790324093
Name:ORTIZ, ANGEL R (RPH)
Entity Type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:R
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 919
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-0919
Mailing Address - Country:US
Mailing Address - Phone:939-439-7452
Mailing Address - Fax:787-869-0620
Practice Address - Street 1:GEORGETTI 139
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-0919
Practice Address - Country:US
Practice Address - Phone:787-869-3965
Practice Address - Fax:787-869-0620
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist