Provider Demographics
NPI:1982075446
Name:OM TSM LLC
Entity Type:Organization
Organization Name:OM TSM LLC
Other - Org Name:DURBIN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNOUTI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:904-619-9000
Mailing Address - Street 1:8681 A C SKINNER PKWY APT 420
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0844
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14965 OLD ST AUGUSTINE RD UNIT 108
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-9481
Practice Address - Country:US
Practice Address - Phone:904-619-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy