Provider Demographics
NPI:1396709507
Name:OMEGA PHARMACY LLC
Entity type:Organization
Organization Name:OMEGA PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JACKSON
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:229-528-4276
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:246 OAK STREET
Mailing Address - City:OMEGA
Mailing Address - State:GA
Mailing Address - Zip Code:31775-0098
Mailing Address - Country:US
Mailing Address - Phone:229-528-4276
Mailing Address - Fax:229-528-4278
Practice Address - Street 1:246 OAK ST
Practice Address - Street 2:
Practice Address - City:OMEGA
Practice Address - State:GA
Practice Address - Zip Code:31775-3087
Practice Address - Country:US
Practice Address - Phone:229-528-4276
Practice Address - Fax:229-528-4278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA44643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000032821AMedicaid
GA000032821AMedicaid