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General NPI Number Information
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NPI Number | 1528630746
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Entity Type | Organization
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Legal Business Name | OM COMPREHENSIVE SERVICES LLC
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Dates
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Enumeration Date | 07/15/2021
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 900 MYER LN # A
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City | KERMIT
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State | TX
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Zip | 79745-4621
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Country | US
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Telephone | 432-309-5160
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Fax | 432-309-5161
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Provider Business Mailing Address
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Address Line | 900 MYER LN
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City | KERMIT
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State | TX
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Zip | 79745-4621
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Country | US
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Telephone | 432-309-5160
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Fax | 432-309-5161
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Authorized Official
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Title or Position | PHARMACIST
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Name | SAM AYILEKA
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Credential |
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Telephone | 432-309-5160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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