Healthcare Provider Details

I. General information

NPI: 1831130491
Provider Name (Legal Business Name): EDGARDO MANUEL ORTIZ PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 PASEO DEL VETERANO
PONCE PR
00716
US

IV. Provider business mailing address

13 CALLE PADRE VICTOR
SALINAS PR
00751-3278
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7581
  • Fax:
Mailing address:
  • Phone: 939-489-7544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number4568
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: