Provider Demographics
NPI:1821751835
Name:ORTEGA, ALEXA SAMANTHA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:SAMANTHA
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 CARROLL AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2917
Mailing Address - Country:US
Mailing Address - Phone:516-606-4488
Mailing Address - Fax:
Practice Address - Street 1:109 CARROLL AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2917
Practice Address - Country:US
Practice Address - Phone:516-606-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-17
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068442183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist