MEDICARE: OMAR P SAUNDERS RPH

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
1	183500000X	Pharmacist	0202210364	VA

General Provider Information

NPI Number	:	1912296070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMAR P SAUNDERS RPH

Provider Business Mailing Address
First Line	:	1201 S COURTHOUSE RD
Second Line	:	APT # 817
City	:	ARLINGTON
State	:	VA
Zip	:	22204-0812
Country	:	US
Telephone Number	:	917-688-8926
Fax Number	:

Provider Business Practice Location Address
First Line	:	1671 CRYSTAL SQUARE ARC
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22202-3322
Country	:	US
Telephone Number	:	703-413-0525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2011
Last Update Date	:	03/29/2011

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