Provider Demographics
NPI:1942433503
Name:OM SAINATH
Entity Type:Organization
Organization Name:OM SAINATH
Other - Org Name:PENINSULA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST /MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIRBALA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-546-3333
Mailing Address - Street 1:2417 N SALISBURY BLVD
Mailing Address - Street 2:UNIT # C
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-2192
Mailing Address - Country:US
Mailing Address - Phone:410-546-3333
Mailing Address - Fax:410-546-1096
Practice Address - Street 1:2417 N SALISBURY BLVD
Practice Address - Street 2:UNIT # C
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-2192
Practice Address - Country:US
Practice Address - Phone:410-546-3333
Practice Address - Fax:410-546-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD050913336C0003X
3336C0004X, 3336H0001X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2134827OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MD6446240001Medicare NSC