MEDICARE: OMA 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	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4296	OTHER	FL	DOC NUMBER

General Provider Information

NPI Number	:	1811292808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMA PHARMACY INC

Provider Business Mailing Address
First Line	:	2736 SW 137TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-6638
Country	:	US
Telephone Number	:	305-485-1720
Fax Number	:	305-485-1722

Provider Business Practice Location Address
First Line	:	2736 SW 137TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-6638
Country	:	US
Telephone Number	:	305-485-1720
Fax Number	:	305-485-1722

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TANIA FORTE
Credential	:
Telephone Number	:	305-485-1720

Provider Enumeration Date	:	01/21/2011
Last Update Date	:	01/21/2011

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Directions to “OMA PHARMACY INC ” Practice Location

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