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General NPI Number Information
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NPI Number | 1255463642
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF TEXAS MEDICAL BRANCH OUTPATIENT PHARMACY
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 301 UNIVERSITY BLVD
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City | GALVESTON
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State | TX
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Zip | 77555-0701
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Country | US
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Telephone | 409-772-7129
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Fax | 409-747-0555
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Provider Business Mailing Address
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Address Line | 301 UNIVERSITY BLVD
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City | GALVESTON
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State | TX
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Zip | 77555-0701
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Country | US
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Telephone | 409-772-7129
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Fax | 409-747-0555
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Authorized Official
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Title or Position | OUTPATIENT PHARMACY MANAGER
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Name | SHARON METYKO
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Credential |
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Telephone | 409-772-7127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 06008
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License Number State | TX
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