Provider Demographics
NPI:1558960666
Name:OSMAN, ABDI (RPH)
Entity Type:Individual
Prefix:
First Name:ABDI
Middle Name:
Last Name:OSMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 SE 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-2999
Mailing Address - Country:US
Mailing Address - Phone:503-797-7826
Mailing Address - Fax:503-797-3170
Practice Address - Street 1:3800 SE 22ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-2999
Practice Address - Country:US
Practice Address - Phone:503-797-7826
Practice Address - Fax:503-797-3170
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist