Provider Demographics
NPI:1215193438
Name:OMAR, LOBNA F (RPH)
Entity Type:Individual
Prefix:
First Name:LOBNA
Middle Name:F
Last Name:OMAR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-5731
Mailing Address - Country:US
Mailing Address - Phone:212-772-0104
Mailing Address - Fax:212-772-6909
Practice Address - Street 1:1299 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-5731
Practice Address - Country:US
Practice Address - Phone:212-772-0104
Practice Address - Fax:212-772-6909
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001443998Medicaid