Provider Demographics
NPI:1699438747
Name:ORTIZ, KYLE NEVIN (PHARM D)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:NEVIN
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MENAUL BLVD NE UNIT 4301
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1533
Mailing Address - Country:US
Mailing Address - Phone:575-202-2685
Mailing Address - Fax:
Practice Address - Street 1:601 MENAUL BLVD NE UNIT 4301
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1533
Practice Address - Country:US
Practice Address - Phone:575-202-2685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00009591183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist