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NPI Code Detail

MEDICARE: ETHAN ORTIZ

MEDICARE: ETHAN ORTIZ
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
1183500000XPharmacist034630GA

General Provider Information

NPI Number : 1972378586
Entity Type Code : Individual
Provider Name (Legal Business Name) : ETHAN ORTIZ
Provider Business Mailing Address
First Line : 2270 US HIGHWAY 17
Second Line :
City : RICHMOND HILL
State : GA
Zip : 31324-3669
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2270 US HIGHWAY 17
Second Line :
City : RICHMOND HILL
State : GA
Zip : 31324-3669
Country : US
Telephone Number : 352-201-4964
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/24/2023
Last Update Date : 11/24/2023

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Directions to “ ETHAN ORTIZ ” Practice Location

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