Provider Demographics
NPI:1912556085
Name:MIAN, OMAR M (PHARMD)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:M
Last Name:MIAN
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 1:8 ETHAN CT
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-3101
Mailing Address - Country:US
Mailing Address - Phone:908-721-8741
Mailing Address - Fax:
Practice Address - Street 1:1105-09 N 63RD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151
Practice Address - Country:US
Practice Address - Phone:215-879-1663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04040900183500000X
PARP453792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist