Healthcare Provider Details

I. General information

NPI: 1972482230
Provider Name (Legal Business Name): BASHAR FAYEZ OTHMAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2025
Last Update Date: 08/30/2025
Certification Date: 08/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 GRANT ST
BUFFALO NY
14213-1902
US

IV. Provider business mailing address

104 CRANBURNE LN
BUFFALO NY
14221-4971
US

V. Phone/Fax

Practice location:
  • Phone: 716-240-9299
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number072061
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: