Provider Demographics
NPI:1831472919
Name:OMAR, DIIS A (PHARMD)
Entity Type:Individual
Prefix:
First Name:DIIS
Middle Name:A
Last Name:OMAR
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 1:4036 ESTERS RD
Mailing Address - Street 2:APT 2024
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-6740
Mailing Address - Country:US
Mailing Address - Phone:469-831-1817
Mailing Address - Fax:
Practice Address - Street 1:2140 E CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-2027
Practice Address - Country:US
Practice Address - Phone:972-889-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-24
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50648183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist