Provider Demographics
NPI:1871830034
Name:MD OMEGA PHARMACY INC
Entity type:Organization
Organization Name:MD OMEGA PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-547-7710
Mailing Address - Street 1:823 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-2529
Mailing Address - Country:US
Mailing Address - Phone:561-547-7710
Mailing Address - Fax:561-547-7719
Practice Address - Street 1:823 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-2529
Practice Address - Country:US
Practice Address - Phone:561-547-7710
Practice Address - Fax:561-547-7719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6078680001OtherMEDICARE ID #
FL032214800Medicaid