MEDICARE: OM SAIDEV 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
2	333600000X	Pharmacy	PP411414L	PA

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
2	2144225	OTHER		PK

General Provider Information

NPI Number	:	1730125287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OM SAIDEV LLC

Provider Business Mailing Address
First Line	:	5360 LINCOLN HWY
Second Line	:	SUITE 10
City	:	GAP
State	:	PA
Zip	:	17527-9451
Country	:	US
Telephone Number	:	717-442-9523
Fax Number	:	717-442-5246

Provider Business Practice Location Address
First Line	:	5360 LINCOLN HWY
Second Line	:	SUITE 10
City	:	GAP
State	:	PA
Zip	:	17527-9451
Country	:	US
Telephone Number	:	717-442-9523
Fax Number	:	717-442-5246

Authorized Official
Title or Position	:	MEMBER
Name	:	UMAMAHESWARA DONEPUDI
Credential	:
Telephone Number	:	717-442-9523

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	01/18/2017

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Directions to “OM SAIDEV LLC ” Practice Location

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