Healthcare Provider Details

I. General information

NPI: 1164029708
Provider Name (Legal Business Name): JOSE A ORTIZ PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

837 S RIVERSIDE DR
ELMHURST IL
60126-4964
US

IV. Provider business mailing address

837 S RIVERSIDE DR
ELMHURST IL
60126-4964
US

V. Phone/Fax

Practice location:
  • Phone: 888-428-3791
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.303466
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: