Provider Demographics
NPI:1619203353
Name:ORTIZ, HERMES JOSE (PHARM D, RPH)
Entity type:Individual
Prefix:DR
First Name:HERMES
Middle Name:JOSE
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4922 S BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1324
Mailing Address - Country:US
Mailing Address - Phone:903-561-6262
Mailing Address - Fax:903-534-0941
Practice Address - Street 1:4922 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1324
Practice Address - Country:US
Practice Address - Phone:903-561-6262
Practice Address - Fax:903-534-0941
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-31
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47684183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist