Provider Demographics
NPI:1871897660
Name:OMOTE RX INC
Entity type:Organization
Organization Name:OMOTE RX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/ OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-377-9700
Mailing Address - Street 1:1430 JOSLYN RD
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48340-2065
Mailing Address - Country:US
Mailing Address - Phone:248-377-9700
Mailing Address - Fax:248-377-9702
Practice Address - Street 1:1430 JOSLYN AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-2065
Practice Address - Country:US
Practice Address - Phone:248-377-9700
Practice Address - Fax:248-377-9702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010094923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy