Provider Demographics
NPI:1629445796
Name:OPITIZ INC
Entity Type:Organization
Organization Name:OPITIZ INC
Other - Org Name:REGAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:UMAMAHESWARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DONEPUDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-490-1600
Mailing Address - Street 1:2068 DANIEL STUART SQ
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3315
Mailing Address - Country:US
Mailing Address - Phone:703-490-1600
Mailing Address - Fax:703-490-6300
Practice Address - Street 1:2068 DANIEL STUART SQ
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3315
Practice Address - Country:US
Practice Address - Phone:703-490-1600
Practice Address - Fax:703-490-6300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-25
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201004677333600000X
3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2154129OtherPK