Basic Information
| Provider Information | |||||||||
| NPI: | 1104590934 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ORTNER | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33205 TEMECULA PKWY | ||||||||
| Address2: | |||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925929142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513033164 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 33205 TEMECULA PKWY | ||||||||
| Address2: | |||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925929142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513033164 | ||||||||
| FaxNumber: | 9513033165 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2021 | ||||||||
| LastUpdateDate: | 08/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 84684 | CA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.