MEDICARE: PJ ORTMANN RPH

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	RP029609L	PA

General Provider Information

NPI Number	:	1912997404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PJ ORTMANN RPH

Provider Business Mailing Address
First Line	:	951 CLEEK AVE
Second Line	:
City	:	LANDISVILLE
State	:	PA
Zip	:	17538-1605
Country	:	US
Telephone Number	:	717-892-3511
Fax Number	:	717-892-3512

Provider Business Practice Location Address
First Line	:	951 CLEEK AVE
Second Line	:
City	:	LANDISVILLE
State	:	PA
Zip	:	17538-1605
Country	:	US
Telephone Number	:	717-892-3511
Fax Number	:	717-892-3512

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	07/08/2007

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