Provider Demographics
NPI:1245553544
Name:OMAR, NIVEEN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:NIVEEN
Middle Name:
Last Name:OMAR
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6212 CHERRY HILL DR
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-1707
Mailing Address - Country:US
Mailing Address - Phone:845-485-0020
Mailing Address - Fax:
Practice Address - Street 1:129 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-4510
Practice Address - Country:US
Practice Address - Phone:845-473-4820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047805183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist