Provider Demographics
NPI:1396106043
Name:ORTIZ MORALES, MARENA DEL SOL (PHARMACY TECNICIAN)
Entity type:Individual
Prefix:
First Name:MARENA
Middle Name:DEL SOL
Last Name:ORTIZ MORALES
Suffix:
Gender:F
Credentials:PHARMACY TECNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7450 N SHEPHERD DR APT 1308
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77091-2468
Mailing Address - Country:US
Mailing Address - Phone:787-627-1241
Mailing Address - Fax:
Practice Address - Street 1:7450 N SHEPHERD DR APT 1308
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77091-2468
Practice Address - Country:US
Practice Address - Phone:787-627-1241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10508183700000X
TX279704183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX279704OtherPHARMACY TECHNICIAN LICENSE
PR10508OtherPHARMACY TECNICIAN LICENSE
TX1177941OtherNABP
TX30066793OtherCPHT CETIFICATE
TX1396106043OtherNPI