=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588581151
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OMNICARE MEDICAL SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2026
-----------------------------------------------------
Last Update Date | 07/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 W 18TH ST UNIT 3
-----------------------------------------------------
City | WEEHAWKEN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07086-6601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-395-7290
-----------------------------------------------------
Fax | 312-395-7290
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 W 18TH ST UNIT 3
-----------------------------------------------------
City | WEEHAWKEN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07086-6601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-395-7290
-----------------------------------------------------
Fax | 312-395-7290
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | YAQUB ALI MOHAMMED
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 312-395-7290
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------