Healthcare Provider Details

I. General information

NPI: 1033817192
Provider Name (Legal Business Name): VINCENT GETANDA OMUYA PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/20/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 W LOOP 338
ODESSA TX
79763-3201
US

IV. Provider business mailing address

10517 N MACARTHUR BLVD APT 2033
IRVING TX
75063-5131
US

V. Phone/Fax

Practice location:
  • Phone: 432-334-8537
  • Fax:
Mailing address:
  • Phone: 214-677-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number71807
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: