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General NPI Number Information
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NPI Number | 1780126250
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Entity Type | Organization
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Legal Business Name | OMNI CARE PHARMACY LLC
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Dates
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Enumeration Date | 11/15/2016
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 4432 HENDRICKS AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32207-6326
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Country | US
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Telephone | 904-423-0123
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Fax | 904-379-6446
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Provider Business Mailing Address
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Address Line | 4432 HENDRICKS AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32207-6326
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Country | US
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Telephone | 904-423-0123
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Fax |
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | DR. WILLIAM PATRICK NIMO
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Credential |
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Telephone | 904-423-0123
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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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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH30259
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License Number State | FL
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