Provider Demographics
NPI:1548374242
Name:OM SAI RX LLC.
Entity type:Organization
Organization Name:OM SAI RX LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PADMAVATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:DITTAKAVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-547-6100
Mailing Address - Street 1:1741 GOLD HILL RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708
Mailing Address - Country:US
Mailing Address - Phone:803-547-6100
Mailing Address - Fax:803-547-7720
Practice Address - Street 1:1741 GOLD HILL RD
Practice Address - Street 2:SUITE 106
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708
Practice Address - Country:US
Practice Address - Phone:803-547-6100
Practice Address - Fax:803-547-7720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC797985Medicaid
SC=========Medicare ID - Type Unspecified