Organization
OMEGA PHARMACY LLC
Active
Other names
Omega Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
AYODEJI ABEJIDE (CHIEF EXECUTIVE OFFICER)
(586) 945-1778
Entity
Organization
Contact information
Practice address
420 W HURON ST, PONTIAC, MI 48341-1425
(248) 481-9004
(248) 481-9168
Mailing address
420 W HURON ST, PONTIAC, MI 48341-1425
(248) 481-9004
(248) 481-9168
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301009758
MI
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114290582
—
MI
01
—
2134037
PK
—
Enumeration date
02/16/2012
Last updated
12/08/2014
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