Healthcare Provider Details

I. General information

NPI: 1154516094
Provider Name (Legal Business Name): ROXANE JEANETTE ORTIZ PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87111-2302
US

IV. Provider business mailing address

8501 PALOMAR AVE NE
ALBUQUERQUE NM
87109-5198
US

V. Phone/Fax

Practice location:
  • Phone: 505-559-9134
  • Fax:
Mailing address:
  • Phone: 505-980-1385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00006758
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: