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General NPI Number Information
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NPI Number | 1821783408
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Entity Type | Individual
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Provider Name | JUDDY OMBASA
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Gender | Female
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Dates
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Enumeration Date | 04/10/2023
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 965 N JUDGE ELY BLVD
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City | ABILENE
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State | TX
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Zip | 79601-4626
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Country | US
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Telephone | 325-677-0616
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Fax |
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Provider Business Mailing Address
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Address Line | 3057 HERITAGE CIR
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City | ABILENE
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State | TX
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Zip | 79606-3314
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Country | US
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Telephone | 682-313-7290
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 69656
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License Number State | TX
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