Healthcare Provider Details

I. General information

NPI: 1265011639
Provider Name (Legal Business Name): OMGANESH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 DOVER PKWY STE C
DELANO CA
93215-3441
US

IV. Provider business mailing address

355 DOVER PKWY STE C
DELANO CA
93215-3441
US

V. Phone/Fax

Practice location:
  • Phone: 661-545-2500
  • Fax: 661-545-2501
Mailing address:
  • Phone: 661-545-2500
  • Fax: 661-545-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NATHANIEL PARK
Title or Position: CEO/PRESIDENT/DIR
Credential:
Phone: 661-545-2500