Provider Demographics
NPI:1912997404
Name:ORTMANN, PJ (RPH)
Entity Type:Individual
Prefix:
First Name:PJ
Middle Name:
Last Name:ORTMANN
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 1:951 CLEEK AVE
Mailing Address - Street 2:
Mailing Address - City:LANDISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17538-1605
Mailing Address - Country:US
Mailing Address - Phone:717-892-3511
Mailing Address - Fax:717-892-3512
Practice Address - Street 1:951 CLEEK AVE
Practice Address - Street 2:
Practice Address - City:LANDISVILLE
Practice Address - State:PA
Practice Address - Zip Code:17538-1605
Practice Address - Country:US
Practice Address - Phone:717-892-3511
Practice Address - Fax:717-892-3512
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP029609L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist