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NPI Code Detail

MEDICARE: OSARO ANTONY OMOFOMWAN

MEDICARE: OSARO ANTONY OMOFOMWAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPST.025738LA

General Provider Information

NPI Number : 1306639166
Entity Type Code : Individual
Provider Name (Legal Business Name) : OSARO ANTONY OMOFOMWAN
Provider Business Mailing Address
First Line : 2228 TIMBERS DR
Second Line :
City : HARVEY
State : LA
Zip : 70058-2228
Country : US
Telephone Number : 504-799-9581
Fax Number :
Provider Business Practice Location Address
First Line : 2001 CAROL SUE AVE
Second Line :
City : GRETNA
State : LA
Zip : 70056-4445
Country : US
Telephone Number : 504-366-1535
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2025
Last Update Date : 05/26/2025

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Directions to “ OSARO ANTONY OMOFOMWAN ” Practice Location

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