Provider Demographics
NPI:1891194742
Name:FARAG, OMAR (PHARMD)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:FARAG
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 1:3175 N PRICE RD
Mailing Address - Street 2:APARTMENT 2273
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-1082
Mailing Address - Country:US
Mailing Address - Phone:480-316-4358
Mailing Address - Fax:
Practice Address - Street 1:1800 E RIO SALADO PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-2255
Practice Address - Country:US
Practice Address - Phone:480-214-2668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-16
Last Update Date:2014-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS020817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist