Provider Demographics
NPI:1346578531
Name:SURIYAMONT, OAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:OAM
Middle Name:
Last Name:SURIYAMONT
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 1:1707 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79763-3423
Mailing Address - Country:US
Mailing Address - Phone:432-332-8258
Mailing Address - Fax:
Practice Address - Street 1:1707 W 8TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763-3423
Practice Address - Country:US
Practice Address - Phone:432-332-8258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-26
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist