Healthcare Provider Details

I. General information

NPI: 1710590849
Provider Name (Legal Business Name): OMM PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

942 MANHATTAN AVE
BROOKLYN NY
11222-1626
US

IV. Provider business mailing address

942 MANHATTAN AVE
BROOKLYN NY
11222-1626
US

V. Phone/Fax

Practice location:
  • Phone: 718-500-4928
  • Fax: 718-500-4927
Mailing address:
  • Phone: 718-500-4928
  • Fax: 718-500-4927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH NAZGINOV
Title or Position: OWNER
Credential:
Phone: 516-780-4018