1578558839 NPI number — OM VIRISAAR PHARMACY INC

Table of content: (NPI 1578558839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578558839 NPI number — OM VIRISAAR PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OM VIRISAAR PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FELDMANS PHARMACY AT CHARTWELL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578558839
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8186 LARK BROWN RD
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
ELKRIDGE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-620-9990
Provider Business Mailing Address Fax Number:
443-620-9993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8186 LARK BROWN RD
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
ELKRIDGE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21075-6433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-620-9990
Provider Business Practice Location Address Fax Number:
443-620-9993
Provider Enumeration Date:
09/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BRAHMANAPALLI
Authorized Official First Name:
RAJKAMAL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/TREASURER
Authorized Official Telephone Number:
443-620-9990

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: P05365 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2126099 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 420115900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com