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General NPI Number Information
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NPI Number | 1063552263
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Entity Type | Organization
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Legal Business Name | OMM, INC
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14454 JEFFERSON DAVIS HWY
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City | WOODBRIDGE
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State | VA
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Zip | 22191-2806
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Country | US
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Telephone | 703-491-7883
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Fax | 703-491-7923
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Provider Business Mailing Address
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Address Line | 14454 JEFFERSON DAVIS HWY
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City | WOODBRIDGE
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State | VA
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Zip | 22191-2806
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Country | US
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Telephone | 703-491-7883
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Fax | 703-491-7923
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Authorized Official
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Title or Position | OWNER
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Name | AMIT Y SHAH
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Credential | PHARMACIST-OWNER
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Telephone | 703-491-7883
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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 | 0202011966
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License Number State | VA
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