Provider Demographics
NPI:1386229904
Name:OMDERA INTEGRATED SERVICES, LLC
Entity type:Organization
Organization Name:OMDERA INTEGRATED SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:AGATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:NWAGWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-953-1970
Mailing Address - Street 1:1330 S POTOMAC ST STE 102
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4527
Mailing Address - Country:US
Mailing Address - Phone:303-953-1970
Mailing Address - Fax:303-953-1864
Practice Address - Street 1:1330 S POTOMAC ST STE 102
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4527
Practice Address - Country:US
Practice Address - Phone:303-953-1970
Practice Address - Fax:303-953-1864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy