Provider Demographics
NPI:1831251453
Name:OZONA PHARMACY, LLC
Entity type:Organization
Organization Name:OZONA PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YANKTON
Authorized Official - Middle Name:SY
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:210-383-5890
Mailing Address - Street 1:813 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:TX
Mailing Address - Zip Code:79714-3618
Mailing Address - Country:US
Mailing Address - Phone:432-523-4861
Mailing Address - Fax:432-524-4418
Practice Address - Street 1:804 11TH ST
Practice Address - Street 2:
Practice Address - City:OZONA
Practice Address - State:TX
Practice Address - Zip Code:76943
Practice Address - Country:US
Practice Address - Phone:325-392-2666
Practice Address - Fax:325-392-2864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33280OtherSTATE LICENSE NUMBER
TX150297Medicaid
TX148646Medicaid