Provider Demographics
NPI:1881661882
Name:OMEGA INTEGRATED HEALTH SYSTEM
Entity Type:Organization
Organization Name:OMEGA INTEGRATED HEALTH SYSTEM
Other - Org Name:OMEGA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:NITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:787-892-5177
Mailing Address - Street 1:PO BOX 166
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0166
Mailing Address - Country:US
Mailing Address - Phone:787-892-5177
Mailing Address - Fax:787-892-5715
Practice Address - Street 1:#102 CALLE SANTIAGO VEVE
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-5177
Practice Address - Fax:787-892-5715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-20643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4016083OtherNABP