Provider Demographics
NPI:1972286425
Name:MEZA, OMAR JACOB (PHARMD)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:JACOB
Last Name:MEZA
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 1:1402 W AJO WAY UNIT 326
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-5777
Mailing Address - Country:US
Mailing Address - Phone:520-891-2505
Mailing Address - Fax:
Practice Address - Street 1:9595 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85748-3210
Practice Address - Country:US
Practice Address - Phone:520-751-7549
Practice Address - Fax:520-751-7699
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS026601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist