Healthcare Provider Details

I. General information

NPI: 1053580068
Provider Name (Legal Business Name): OMAR MOHAMMAD PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2008
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 GRISTMILL LN
UPPER SADDLE RIVER NJ
07458-1316
US

IV. Provider business mailing address

15 GRISTMILL LN
UPPER SADDLE RIVER NJ
07458-1316
US

V. Phone/Fax

Practice location:
  • Phone: 201-657-1707
  • Fax:
Mailing address:
  • Phone: 201-657-1707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051927
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: