Healthcare Provider Details

I. General information

NPI: 1053622035
Provider Name (Legal Business Name): OMAR ZOOBI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 W COLONIAL DR
ORLANDO FL
32801-1109
US

IV. Provider business mailing address

318 W COLONIAL DR
ORLANDO FL
32801-1109
US

V. Phone/Fax

Practice location:
  • Phone: 407-668-4945
  • Fax: 407-704-1429
Mailing address:
  • Phone: 407-668-4945
  • Fax: 407-704-1429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS31386
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: