Provider Demographics
NPI:1003474453
Name:OMAR, GAMAL (RPH)
Entity type:Individual
Prefix:MR
First Name:GAMAL
Middle Name:
Last Name:OMAR
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 1:10371 HENBURY ST UNIT 207
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6954
Mailing Address - Country:US
Mailing Address - Phone:407-492-3041
Mailing Address - Fax:
Practice Address - Street 1:3990 E STAE RD 44
Practice Address - Street 2:UNIT 207
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-3478
Practice Address - Country:US
Practice Address - Phone:352-492-9333
Practice Address - Fax:352-399-6234
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32144183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS32144OtherFLORIDA BOARD OF PHRMACY