Provider Demographics
NPI:1669637278
Name:OOMMEN, JOHN THALESSERIL (PHARM D)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THALESSERIL
Last Name:OOMMEN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 638
Mailing Address - Street 2:
Mailing Address - City:BRODHEADSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18322
Mailing Address - Country:US
Mailing Address - Phone:570-992-2373
Mailing Address - Fax:570-992-2617
Practice Address - Street 1:2314 E INTERSTATE HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-8685
Practice Address - Country:US
Practice Address - Phone:965-585-3990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP439531183500000X
TX64701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist