Om TSM LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH25921 Issued in FL

Legal business name

OM TSM LLC

Practice address

14965 Old Saint Augustine Rd Unit 108
Jacksonville, FL 32258-9481

Phone

(904) 619-9000

Fax

(904) 634-7458

NPI assigned

Jan 31, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Om TSM, PHARM D

Title

Managing Member/Owner

Phone

(904) 619-9000

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Durbin Pharmacy Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Tax ID family

Durbin Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Om TSM LLC

  • Compounding Pharmacy
  • Jacksonville, FL
  • NPI 1982075446
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1327968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456963200000",
    "number": "1104198688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14965 OLD SAINT AUGUSTINE RD UNIT 108",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322589481",
            "telephone_number": "904-619-9000",
            "fax_number": "904-634-7458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14965 OLD SAINT AUGUSTINE RD UNIT 108",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322589481",
            "telephone_number": "904-619-9000",
            "fax_number": "904-634-7458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OM TSM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-31",
        "last_updated": "2016-03-03",
        "status": "A",
        "authorized_official_last_name": "TSM",
        "authorized_official_first_name": "OM",
        "authorized_official_title_or_position": "MANAGING MEMBER/OWNER",
        "authorized_official_telephone_number": "904-619-9000",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH25921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2133655",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004947900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Durbin Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Antionette L Olukunle
• Jeremiah Tobi Oluwadamisi, M.D.
• Valeria Olvera
• Eamon Terence Olwell, MD
• Om Shri Ganesh LLC
• Om TSM LLC
• Omajus Medical Services LLC
• Sven Peter Oman, MD
• Omar Kawwaff
• Zuha Omar

• Community/Retail Pharmacy in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.