Provider Demographics
NPI:1376131847
Name:RAOOF, OSAMA ABDUL
Entity Type:Individual
Prefix:
First Name:OSAMA
Middle Name:ABDUL
Last Name:RAOOF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 SW 39TH ST APT 208
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-2405
Mailing Address - Country:US
Mailing Address - Phone:410-428-3659
Mailing Address - Fax:
Practice Address - Street 1:65 NW 167TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-6017
Practice Address - Country:US
Practice Address - Phone:305-655-1544
Practice Address - Fax:305-655-1547
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-09
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58162183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist