Provider Demographics
NPI:1811561046
Name:MEDIOAK PHARMACY LLC
Entity Type:Organization
Organization Name:MEDIOAK PHARMACY LLC
Other - Org Name:MEDIOAK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:OTIBHOR
Authorized Official - Middle Name:
Authorized Official - Last Name:ONOSODE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:281-980-9979
Mailing Address - Street 1:3129 HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4367
Mailing Address - Country:US
Mailing Address - Phone:281-980-9979
Mailing Address - Fax:
Practice Address - Street 1:3129 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4367
Practice Address - Country:US
Practice Address - Phone:281-980-9979
Practice Address - Fax:281-993-5129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy