Provider Demographics
NPI:1043543234
Name:O&M PHARMACY INC
Entity Type:Organization
Organization Name:O&M PHARMACY INC
Other - Org Name:O&M PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ONUORAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-338-7730
Mailing Address - Street 1:1630 HOUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-3319
Mailing Address - Country:US
Mailing Address - Phone:409-984-9919
Mailing Address - Fax:409-984-9923
Practice Address - Street 1:1630 HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-3319
Practice Address - Country:US
Practice Address - Phone:409-984-9919
Practice Address - Fax:409-984-9923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-07
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
TX266133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146062Medicaid
2121859OtherPK