Provider Demographics
NPI:1003565938
Name:OMNIA PHARMACY INC
Entity Type:Organization
Organization Name:OMNIA PHARMACY INC
Other - Org Name:OMNIA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:EISSA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:702-405-8585
Mailing Address - Street 1:1807 W CHARLESTON BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2328
Mailing Address - Country:US
Mailing Address - Phone:702-405-8585
Mailing Address - Fax:702-405-8769
Practice Address - Street 1:1807 W CHARLESTON BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2328
Practice Address - Country:US
Practice Address - Phone:702-405-8585
Practice Address - Fax:702-405-8769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-18
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy