MEDICARE: PEDRO ESTEBAN ORTIZ COLON PHARMD

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	183500000X	Pharmacist	PS63480	FL

General Provider Information

NPI Number	:	1902562168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEDRO ESTEBAN ORTIZ COLON PHARMD

Provider Business Mailing Address
First Line	:	4492 LAKE TAHOE CIR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-7854
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4492 LAKE TAHOE CIR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-7854
Country	:	US
Telephone Number	:	706-495-5245
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2021
Last Update Date	:	11/11/2021

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