Provider Demographics
NPI:1528630746
Name:OM COMPREHENSIVE SERVICES LLC
Entity type:Organization
Organization Name:OM COMPREHENSIVE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AYILEKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-309-5160
Mailing Address - Street 1:900 MYER LN
Mailing Address - Street 2:
Mailing Address - City:KERMIT
Mailing Address - State:TX
Mailing Address - Zip Code:79745-4621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 MYER LN # A
Practice Address - Street 2:
Practice Address - City:KERMIT
Practice Address - State:TX
Practice Address - Zip Code:79745-4621
Practice Address - Country:US
Practice Address - Phone:713-835-2312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-15
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy