Organization
OM TSM LLC
Active
Other names
Durbin Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
OM TSM PHARM D (MANAGING MEMBER/OWNER)
(904) 619-9000
Entity
Organization
Contact information
Practice address
14965 OLD SAINT AUGUSTINE RD UNIT 108, JACKSONVILLE, FL 32258-9481
(904) 619-9000
(904) 634-7458
Mailing address
14965 OLD SAINT AUGUSTINE RD UNIT 108, JACKSONVILLE, FL 32258-9481
(904) 619-9000
(904) 634-7458
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH25921
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004947900
—
FL
01
—
2133655
PK
—
Enumeration date
01/31/2012
Last updated
03/03/2016
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