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General NPI Number Information
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NPI Number | 1649909912
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Entity Type | Individual
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Provider Name | MOHAMED OMAR
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Gender | Male
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Dates
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Enumeration Date | 06/10/2022
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Last Update Date | 06/11/2022
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Provider Practice Location Address
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Address Line | 205 8TH AVE
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City | NEW YORK
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State | NY
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Zip | 10011-1617
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Country | US
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Telephone | 212-691-9050
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Fax |
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Provider Business Mailing Address
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Address Line | 8402 4TH AVE APT D5
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City | BROOKLYN
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State | NY
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Zip | 11209-4651
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 069099
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License Number State | NY
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