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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