Healthcare Provider Details

I. General information

NPI: 1316203524
Provider Name (Legal Business Name): OMG PHARMACY DISCOUNT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7305 NW 36TH ST
MIAMI FL
33166-6704
US

IV. Provider business mailing address

7305 NW 36TH ST
MIAMI FL
33166-6704
US

V. Phone/Fax

Practice location:
  • Phone: 305-629-9032
  • Fax: 305-629-9034
Mailing address:
  • Phone: 305-629-9032
  • Fax: 305-629-9034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateFL

VIII. Authorized Official

Name: ALAYN BOU
Title or Position: PRESIDENT
Credential:
Phone: 305-629-9032