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General NPI Number Information
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NPI Number | 1104627504
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Entity Type | Organization
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Legal Business Name | OM VIRISSAR PHARMACY, INC
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Dates
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Enumeration Date | 03/21/2025
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 8186 LARK BROWN RD STE 101
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City | ELKRIDGE
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State | MD
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Zip | 21075-6437
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Country | US
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Telephone | 443-620-9990
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Fax |
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Provider Business Mailing Address
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Address Line | 8186 LARK BROWN RD STE 101
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City | ELKRIDGE
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State | MD
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Zip | 21075-6437
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Country | US
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Telephone | 443-620-9990
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. EMMANUEL NDE
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Credential | PHARMD
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Telephone | 571-365-1833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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