Provider Demographics
NPI:1972153971
Name:AL-OMAR, LANA TAHSIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:TAHSIN
Last Name:AL-OMAR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:TAHSON
Other - Last Name:ALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15614 BERNARDO CENTER DR APT 3005
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1860
Mailing Address - Country:US
Mailing Address - Phone:729-949-8687
Mailing Address - Fax:
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9000
Practice Address - Country:US
Practice Address - Phone:858-657-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80205183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist