Provider Demographics
NPI:1922313303
Name:AWESOME CARE PHARMACY INC
Entity Type:Organization
Organization Name:AWESOME CARE PHARMACY INC
Other - Org Name:AWESOME CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OKPALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-922-0594
Mailing Address - Street 1:6060 BELLAIRE BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-5425
Mailing Address - Country:US
Mailing Address - Phone:832-922-0594
Mailing Address - Fax:281-437-2148
Practice Address - Street 1:6060 BELLAIRE BLVD
Practice Address - Street 2:STE J
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-5425
Practice Address - Country:US
Practice Address - Phone:281-501-1008
Practice Address - Fax:281-974-4368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX272453336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2127632OtherPK
TX148945Medicaid