Healthcare Provider Details

I. General information

NPI: 1295656940
Provider Name (Legal Business Name): OMAR SHAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 LAKEWOOD RANCH BLVD
SARASOTA FL
34240-8855
US

IV. Provider business mailing address

4964 CANDLEBUSH CIR
SARASOTA FL
34241-6203
US

V. Phone/Fax

Practice location:
  • Phone: 941-271-6985
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS70991
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: