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General NPI Number Information
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NPI Number | 1104181544
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Entity Type | Individual
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Provider Name | DENNIS LUKE ORTEGO RPH
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Gender | Male
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 07/11/2012
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Provider Practice Location Address
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Address Line | 1210 ALBERTSON PKWY
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City | BROUSSARD
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State | LA
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Zip | 70518-4347
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Country | US
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Telephone | 337-839-0530
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Fax | 337-839-1432
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Provider Business Mailing Address
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Address Line | 1210 ALBERTSON PKWY
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City | BROUSSARD
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State | LA
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Zip | 70518
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Country | US
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Telephone | 337-839-0530
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Fax | 337-839-1432
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 9720
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License Number State | LA
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