MEDICARE: OMAR PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	054018853	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2157442	OTHER		PK

General Provider Information

NPI Number	:	1285099002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMAR PHARMACY INC

Provider Business Mailing Address
First Line	:	4713 N SHERIDAN RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640
Country	:	US
Telephone Number	:	773-681-0080
Fax Number	:

Provider Business Practice Location Address
First Line	:	4613 N SHERIDAN RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5019
Country	:	US
Telephone Number	:	773-681-0080
Fax Number	:	773-754-7563

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	HANI ABDALLAH
Credential	:
Telephone Number	:	773-681-0080

Provider Enumeration Date	:	12/21/2015
Last Update Date	:	04/11/2016

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