Basic Information
| Provider Information | |||||||||
| NPI: | 1417502980 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ORTIZ | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | ANDRES | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5311 REDFIELD LN | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336241031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132445908 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4525 GUNN HWY | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336246311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132616088 | ||||||||
| FaxNumber: | 8132616087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2019 | ||||||||
| LastUpdateDate: | 08/01/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PS21417 | FL | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.