NPIMap

Organization Active NPI

Omegamarg Pharmacy Inc

  • Long Term Care Pharmacy
  • San Anselmo, CA
National Provider Identifier
1386673556
Registry record updated Jul 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
PHY49029 Issued in CA
Legal business name
OMEGAMARG PHARMACY INC
Practice address
121 Tunstead Ave
San Anselmo, CA 94960-2616
Phone
(415) 454-1451
Fax
(415) 454-2865
NPI assigned
Jul 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2018

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

Authorized official

Name
Srinivas Katpelly
Title
President
Phone
(415) 454-1451

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X
Long Term Care Pharmacy 3336L0003X PHY49029 CA Primary

Addresses

Primary practice location

121 Tunstead Ave
San Anselmo, CA 94960-2616

Mailing address

121 Tunstead Ave
San Anselmo, CA 94960-2616
Phone (415) 454-1451

Other identifiers 2

IdentifierTypeStateIssuer
PHA375550MedicaidCA
1996097OtherPK

Other names 1

  • JACKS DRUG STORE AND MEDICAL SUPPLIES Doing business as

National Provider Directory

National Provider Directory

Locations

121 Tunstead Ave
San Anselmo, CA 94960
Phone (415) 454-1451

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531958400000",
    "number": "1386673556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 TUNSTEAD AVE",
            "city": "SAN ANSELMO",
            "state": "CA",
            "postal_code": "949602616",
            "telephone_number": "415-454-1451",
            "fax_number": "415-454-2865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 TUNSTEAD AVE",
            "city": "SAN ANSELMO",
            "state": "CA",
            "postal_code": "949602616",
            "telephone_number": "415-454-1451",
            "fax_number": "415-454-2865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMEGAMARG PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-01",
        "last_updated": "2018-07-19",
        "status": "A",
        "authorized_official_last_name": "KATPELLY",
        "authorized_official_first_name": "SRINIVAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "415-454-1451"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "CA",
            "license": "PHY49029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA375550",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1996097",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JACKS DRUG STORE AND MEDICAL SUPPLIES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Anselmo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.