Provider Demographics
NPI:1821657149
Name:OM HEALTHCARE LLC
Entity Type:Organization
Organization Name:OM HEALTHCARE LLC
Other - Org Name:PRIMECARE PHARMACY #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIRAV
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:210-475-3282
Mailing Address - Street 1:602 BANDERA ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228
Mailing Address - Country:US
Mailing Address - Phone:210-475-3282
Mailing Address - Fax:210-475-3285
Practice Address - Street 1:602 BANDERA ROAD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228
Practice Address - Country:US
Practice Address - Phone:210-475-3282
Practice Address - Fax:210-475-3285
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OM HEALTHCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-10
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy