Provider Demographics
NPI:1073050969
Name:OMETE, PHOEBE
Entity Type:Individual
Prefix:
First Name:PHOEBE
Middle Name:
Last Name:OMETE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18484 PRESTON RD STE 112
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5474
Mailing Address - Country:US
Mailing Address - Phone:469-814-0919
Mailing Address - Fax:469-814-0603
Practice Address - Street 1:18484 PRESTON RD STE 112
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5474
Practice Address - Country:US
Practice Address - Phone:469-814-0919
Practice Address - Fax:469-814-0603
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist