Provider Demographics
NPI:1255463642
Name:UNIVERSITY OF TEXAS MEDICAL BRANCH OUTPATIENT PHARMACY
Entity type:Organization
Organization Name:UNIVERSITY OF TEXAS MEDICAL BRANCH OUTPATIENT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTPATIENT PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:METYKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-772-7127
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0701
Mailing Address - Country:US
Mailing Address - Phone:409-772-7129
Mailing Address - Fax:409-747-0555
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0701
Practice Address - Country:US
Practice Address - Phone:409-772-7129
Practice Address - Fax:409-747-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06008261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center