Organization
OM SHRI GANESH LLC
Active
Organization
OM SHRI GANESH LLC
Active
Other names
Ricker Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TEJAS PATEL (MANAGING MEMBER)
(904) 208-8137
Entity
Organization
Contact information
Practice address
7628 103RD ST STE 5, JACKSONVILLE, FL 32210-8719
(904) 900-3500
(904) 900-3505
Mailing address
7628 103RD ST STE 5, JACKSONVILLE, FL 32210-8719
(904) 900-3500
(904) 900-3505
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH25990
FL
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006295900
—
FL
01
—
2134119
PK
—
Enumeration date
03/07/2012
Last updated
03/21/2024
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