Provider Demographics
NPI:1174102586
Name:ST MICHAEL'S PHARMACY LLC
Entity type:Organization
Organization Name:ST MICHAEL'S PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:OMOLEME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-236-9776
Mailing Address - Street 1:5102 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-2014
Mailing Address - Country:US
Mailing Address - Phone:281-762-1120
Mailing Address - Fax:281-762-0544
Practice Address - Street 1:5102 AVENUE H
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-2014
Practice Address - Country:US
Practice Address - Phone:281-762-1120
Practice Address - Fax:281-762-0544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-04
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty