# OMEGAMARG PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** JACKS DRUG STORE AND MEDICAL SUPPLIES
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386673556
- **Authorized official:** SRINIVAS KATPELLY (PRESIDENT)
- **Authorized official phone:** (415) 454-1451

## Contact information

- **Practice address:** 121 TUNSTEAD AVE, SAN ANSELMO, CA 94960-2616
- **Practice address phone:** (415) 454-1451
- **Practice address fax:** (415) 454-2865
- **Mailing address:** 121 TUNSTEAD AVE, SAN ANSELMO, CA 94960-2616
- **Mailing address phone:** (415) 454-1451
- **Mailing address fax:** (415) 454-2865

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | PHY49029 | CA | Yes |

## Other

- **Enumeration date:** 07/01/2006
- **Last updated:** 07/19/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1996097 | PK | — |
| 05 | — | PHA375550 | — | CA |