Provider Demographics
NPI:1154516094
Name:ORTIZ, ROXANE JEANETTE (PHARMD)
Entity type:Individual
Prefix:MISS
First Name:ROXANE
Middle Name:JEANETTE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 PALOMAR AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-5198
Mailing Address - Country:US
Mailing Address - Phone:505-980-1385
Mailing Address - Fax:
Practice Address - Street 1:8400 MONTGOMERY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2302
Practice Address - Country:US
Practice Address - Phone:505-559-9134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006758183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist