Organization
OMEGAMARG PHARMACY INC
Active
Other names
JACKS DRUG STORE AND MEDICAL SUPPLIES
Organization subpart
No
Provider details
NPI number
Authorized official
SRINIVAS KATPELLY (PRESIDENT)
(415) 454-1451
Entity
Organization
Contact information
Practice address
121 TUNSTEAD AVE, SAN ANSELMO, CA 94960-2616
(415) 454-1451
(415) 454-2865
Mailing address
121 TUNSTEAD AVE, SAN ANSELMO, CA 94960-2616
(415) 454-1451
(415) 454-2865
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
PHY49029
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1996097
PK
—
05
—
PHA375550
—
CA
Enumeration date
07/01/2006
Last updated
07/19/2018
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