Healthcare Provider Details

I. General information

NPI: 1053190116
Provider Name (Legal Business Name): BRENDA ORTEGA PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E PIONEER PKWY
ARLINGTON TX
76010-5243
US

IV. Provider business mailing address

2126 STONEGATE ST
ARLINGTON TX
76010-3153
US

V. Phone/Fax

Practice location:
  • Phone: 817-860-9510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number73135
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: