Healthcare Provider Details

I. General information

NPI: 1093149544
Provider Name (Legal Business Name): TRAVIS HECTOR ORTIZ PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2013
Last Update Date: 09/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 W 25TH AVE UNIT A
ANCHORAGE AK
99503-1629
US

IV. Provider business mailing address

1429 W 25TH AVE UNIT A
ANCHORAGE AK
99503-1629
US

V. Phone/Fax

Practice location:
  • Phone: 907-317-7089
  • Fax:
Mailing address:
  • Phone: 907-317-7089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number3884
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: