MEDICARE: INI UMOREN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	54399	TX

General Provider Information

NPI Number	:	1487584207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INI UMOREN

Provider Business Mailing Address
First Line	:	3413 PONCE DE LEON CT
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-2247
Country	:	US
Telephone Number	:	850-591-2341
Fax Number	:

Provider Business Practice Location Address
First Line	:	3413 PONCE DE LEON CT
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-2247
Country	:	US
Telephone Number	:	850-591-2341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2026
Last Update Date	:	05/22/2026

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Directions to “ INI UMOREN ” Practice Location

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