Healthcare Provider Details

I. General information

NPI: 1942433503
Provider Name (Legal Business Name): OM SAINATH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2417 N SALISBURY BLVD UNIT # C
SALISBURY MD
21801-2192
US

IV. Provider business mailing address

2417 N SALISBURY BLVD UNIT # C
SALISBURY MD
21801-2192
US

V. Phone/Fax

Practice location:
  • Phone: 410-546-3333
  • Fax: 410-546-1096
Mailing address:
  • Phone: 410-546-3333
  • Fax: 410-546-1096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number05091
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: VIRBALA PATEL
Title or Position: PHARMACIST /MANAGER
Credential:
Phone: 410-546-3333