Provider Demographics
NPI:1710590849
Name:OMM PHARMACY LLC
Entity Type:Organization
Organization Name:OMM PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KAVITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KONDAPALLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-500-4928
Mailing Address - Street 1:942 MANHATTAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-1626
Mailing Address - Country:US
Mailing Address - Phone:718-500-4928
Mailing Address - Fax:718-500-4927
Practice Address - Street 1:942 MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-1626
Practice Address - Country:US
Practice Address - Phone:718-500-4928
Practice Address - Fax:718-500-4927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy