Provider Demographics
NPI:1821072414
Name:ORTEGA, JENNIFER ELICE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELICE
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W ROSEDALE ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4621
Mailing Address - Country:US
Mailing Address - Phone:817-920-6722
Mailing Address - Fax:817-920-6748
Practice Address - Street 1:600 W ROSEDALE ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4621
Practice Address - Country:US
Practice Address - Phone:817-920-6722
Practice Address - Fax:817-920-6748
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX338531835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy