Provider Demographics
NPI:1629385141
Name:MORA, ROBERT OMAR (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:OMAR
Last Name:MORA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9828 BLACKHAWK BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075-2246
Mailing Address - Country:US
Mailing Address - Phone:713-991-3762
Mailing Address - Fax:713-991-5419
Practice Address - Street 1:9828 BLACKHAWK BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075-2246
Practice Address - Country:US
Practice Address - Phone:713-991-3762
Practice Address - Fax:713-991-5419
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist