Provider Demographics
NPI:1003422650
Name:MY DELIVERY PHARMACY
Entity Type:Organization
Organization Name:MY DELIVERY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:SYLVESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:OSA-IYARE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:281-717-8760
Mailing Address - Street 1:6356 S PEEK RD STE 1200
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-7190
Mailing Address - Country:US
Mailing Address - Phone:281-717-8760
Mailing Address - Fax:281-717-8762
Practice Address - Street 1:6356 S PEEK RD STE 1200
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-7190
Practice Address - Country:US
Practice Address - Phone:281-717-8760
Practice Address - Fax:281-717-8762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150338Medicaid