Healthcare Provider Details

I. General information

NPI: 1881661882
Provider Name (Legal Business Name): OMEGA INTEGRATED HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#102 CALLE SANTIAGO VEVE
SAN GERMAN PR
00683
US

IV. Provider business mailing address

PO BOX 166
SAN GERMAN PR
00683-0166
US

V. Phone/Fax

Practice location:
  • Phone: 787-892-5177
  • Fax: 787-892-5715
Mailing address:
  • Phone: 787-892-5177
  • Fax: 787-892-5715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number07-F-2064
License Number StatePR

VIII. Authorized Official

Name: MRS. NITZA ACOSTA
Title or Position: PHARMACIST
Credential: RPH
Phone: 787-892-5177