Organization Active NPI

Omega Pharmacy LLC

  • Community/Retail Pharmacy
  • Omega, GA
National Provider Identifier
1396709507
Registry record updated Jan 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
4464 Issued in GA
Legal business name
OMEGA PHARMACY LLC
Practice address
246 Oak St
Omega, GA 31775-3087
Phone
(229) 528-4276
Fax
(229) 528-4278
NPI assigned
Apr 14, 2006
Last updated
Jan 30, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2017

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

Authorized official

Name
Jackson Thomas Lindsey, RPH
Title
Pharmacist
Phone
(229) 528-4276

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 4464 GA Primary

Addresses

Primary practice location

246 Oak St
Omega, GA 31775-3087

Mailing address

PO Box 98
246 Oak Street
Omega, GA 31775-0098
Phone (229) 528-4276

Other identifiers 1

IdentifierTypeStateIssuer
000032821AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20091014000405 GA Part B Supplier - Other 1759427230 Practice locations: Omega, GA
O20100930071197 GA DME Supplier - Pharmacy 1759427230 Practice locations: Omega, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2172935Omega Pharmacy246 Oak Street, Omega, GA 31775Certificate of waiverOct 1, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Omega Pharmacy LLC246 Oak St, Omega, GA 31775-3087(229) 528-4276 Nebulizer Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Nebulizer Equipment and/or Supplies Does not accept assignmentParticipating since Oct 18, 2006

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485734400000",
    "number": "1396709507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 98",
            "address_2": "246 OAK STREET",
            "city": "OMEGA",
            "state": "GA",
            "postal_code": "317750098",
            "telephone_number": "229-528-4276",
            "fax_number": "229-528-4278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "246 OAK ST",
            "city": "OMEGA",
            "state": "GA",
            "postal_code": "317753087",
            "telephone_number": "229-528-4276",
            "fax_number": "229-528-4278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMEGA PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-14",
        "last_updated": "2017-01-30",
        "status": "A",
        "authorized_official_last_name": "LINDSEY",
        "authorized_official_first_name": "JACKSON",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "229-528-4276",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "4464",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000032821A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Omega, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.