MEDICARE: MIGUEL ANGEL ORTIZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	2972	PR

General Provider Information

NPI Number	:	1457456824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIGUEL ANGEL ORTIZ

Provider Business Mailing Address
First Line	:	VAMC LAKE CITY
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32056-9000
Country	:	US
Telephone Number	:	800-308-8387
Fax Number	:

Provider Business Practice Location Address
First Line	:	VAMC LAKE CITY
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32056-9000
Country	:	US
Telephone Number	:	800-308-8387
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	07/08/2007

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Directions to “ MIGUEL ANGEL ORTIZ ” Practice Location

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