| NPI | 1821171158 |
|---|---|
| Doing Business As | KEIICHIRO OMORI MD |
| Entity Type | Organization |
| Authorized Contact | DIRENDIA SHACKELFORD Managed Care Specialist 800-654-0889 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: CA A26248) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2020-08-22 |