MEDICARE: OMAR ISMAIL PHARMD

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	183500000X	Pharmacist	28RI04202700	NJ

General Provider Information

NPI Number	:	1952073470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMAR ISMAIL PHARMD

Provider Business Mailing Address
First Line	:	1225 KENNEDY BLVD APT 7E APT 7E
Second Line	:
City	:	BAYONNE
State	:	NJ
Zip	:	07002
Country	:	US
Telephone Number	:	201-779-7608
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 JACK MARTIN BLVD, BRICK TOWNSHIP, NJ 08724
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724
Country	:	US
Telephone Number	:	732-840-2200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2021
Last Update Date	:	10/03/2021

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