Healthcare Provider Details

I. General information

NPI: 1245553544
Provider Name (Legal Business Name): NIVEEN OMAR PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 SOUTH AVE
POUGHKEEPSIE NY
12601-4510
US

IV. Provider business mailing address

6212 CHERRY HILL DR
POUGHKEEPSIE NY
12603-1707
US

V. Phone/Fax

Practice location:
  • Phone: 845-473-4820
  • Fax:
Mailing address:
  • Phone: 845-485-0020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number047805
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: