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General NPI Number Information
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NPI Number | 1013468370
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Entity Type | Organization
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Legal Business Name | OMNISALUS INC
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Dates
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Enumeration Date | 10/20/2016
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Last Update Date | 02/15/2018
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Provider Practice Location Address
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Address Line | 3110 NEW BERN AVE STE 108
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City | RALEIGH
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State | NC
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Zip | 27610-1200
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Country | US
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Telephone | 919-703-0717
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Fax | 919-703-0861
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Provider Business Mailing Address
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Address Line | 3110 NEW BERN AVE STE 108
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City | RALEIGH
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State | NC
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Zip | 27610-1200
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Country | US
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Telephone | 919-703-0717
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Fax | 919-703-0861
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Authorized Official
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Title or Position | PHARMACY DIRECTOR
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Name | ELVIS TANYI
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Credential | PHARM.D, MBA
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Telephone | 919-757-8290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 19478
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 13181
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License Number State | NC
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