=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407081607
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OME DRUG CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2009
-----------------------------------------------------
Last Update Date | 03/31/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1611 BROADWAY STORE B
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11207-1002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-942-4842
-----------------------------------------------------
Fax | 718-942-4840
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1611 BROADWAY STORE B
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11207-1002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-942-4842
-----------------------------------------------------
Fax | 718-942-4840
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY
-----------------------------------------------------
Name | MARCO ALKADA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-942-4842
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 029406
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------