Healthcare Provider Details

I. General information

NPI: 1730811985
Provider Name (Legal Business Name): OMAR AMIGON PHARM D. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 06/27/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 BLAIRS FERRY RD NE
CEDAR RAPIDS IA
52402-1802
US

IV. Provider business mailing address

2805 WATER ST
COLUMBUS CITY IA
52737-9468
US

V. Phone/Fax

Practice location:
  • Phone: 319-393-2110
  • Fax:
Mailing address:
  • Phone: 319-212-0142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24423
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: