MEDICARE: OM VIRISAAR PHARMACY INC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	P05365	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2126099	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578558839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OM VIRISAAR PHARMACY INC

Provider Business Mailing Address
First Line	:	8186 LARK BROWN RD
Second Line	:	STE 101
City	:	ELKRIDGE
State	:	MD
Zip	:	21075
Country	:	US
Telephone Number	:	443-620-9990
Fax Number	:	443-620-9993

Provider Business Practice Location Address
First Line	:	8186 LARK BROWN RD
Second Line	:	STE 101
City	:	ELKRIDGE
State	:	MD
Zip	:	21075-6433
Country	:	US
Telephone Number	:	443-620-9990
Fax Number	:	443-620-9993

Authorized Official
Title or Position	:	OWNER/TREASURER
Name	:	RAJKAMAL BRAHMANAPALLI
Credential	:	RPH
Telephone Number	:	443-620-9990

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	09/19/2025

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