Provider Demographics
NPI:1437445335
Name:ORTIZ, MILTON JR (RPH)
Entity type:Individual
Prefix:MR
First Name:MILTON
Middle Name:
Last Name:ORTIZ
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 WESTCHESTER AVE
Mailing Address - Street 2:EVE III PHARMACY INC
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455
Mailing Address - Country:US
Mailing Address - Phone:718-292-9292
Mailing Address - Fax:718-292-6679
Practice Address - Street 1:612 WESTCHESTER AVE
Practice Address - Street 2:EVE III PHARMACY INC
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455
Practice Address - Country:US
Practice Address - Phone:718-292-9292
Practice Address - Fax:718-292-6679
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5160610001Medicare UPIN