MEDICARE: OM SAI RX LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548374242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OM SAI RX LLC.

Provider Business Mailing Address
First Line	:	1741 GOLD HILL RD
Second Line	:	SUITE 106
City	:	FORT MILL
State	:	SC
Zip	:	29708
Country	:	US
Telephone Number	:	803-547-6100
Fax Number	:	803-547-7720

Provider Business Practice Location Address
First Line	:	1741 GOLD HILL RD
Second Line	:	SUITE 106
City	:	FORT MILL
State	:	SC
Zip	:	29708
Country	:	US
Telephone Number	:	803-547-6100
Fax Number	:	803-547-7720

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PADMAVATHI DITTAKAVI
Credential	:
Telephone Number	:	803-547-6100

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	05/15/2024

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Directions to “OM SAI RX LLC. ” Practice Location

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