MEDICARE: CARTERS ORTEGA PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	PS6642	FL

General Provider Information

NPI Number	:	1760581375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARTERS ORTEGA PHARMACY

Provider Business Mailing Address
First Line	:	2923 CORINTHIAN AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-4401
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2923 CORINTHIAN AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-4401
Country	:	US
Telephone Number	:	904-389-5558
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GREGORY CARTER
Credential	:
Telephone Number	:	904-389-4355

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	08/22/2020

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