Healthcare Provider Details

I. General information

NPI: 1265279095
Provider Name (Legal Business Name): OMAR HAJMOUSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

IV. Provider business mailing address

1450 HOLLOW RUN APT 5
CENTERVILLE OH
45459-5865
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-9199
  • Fax:
Mailing address:
  • Phone: 937-993-6974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03444374
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: