Provider Demographics
NPI:1881446425
Name:AVILES ORTIZ, ANGEL OMAR (PHARMD)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:OMAR
Last Name:AVILES ORTIZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N WEST ST APT 414
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-6183
Mailing Address - Country:US
Mailing Address - Phone:787-354-0046
Mailing Address - Fax:
Practice Address - Street 1:9640 LEESVILLE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-5970
Practice Address - Country:US
Practice Address - Phone:919-745-4938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist