Provider Demographics
NPI:1023537370
Name:SALEH, OMAR AMGAD (PHARMD)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:AMGAD
Last Name:SALEH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 BRANFORD LN
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-6121
Mailing Address - Country:US
Mailing Address - Phone:630-335-7780
Mailing Address - Fax:
Practice Address - Street 1:16750 W 159TH ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-7968
Practice Address - Country:US
Practice Address - Phone:815-834-1351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.300690183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist