Provider Demographics
NPI:1669717484
Name:OMAR, YASIN (PHARMD)
Entity type:Individual
Prefix:MR
First Name:YASIN
Middle Name:
Last Name:OMAR
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 1:69 NORFRED DR
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-2036
Mailing Address - Country:US
Mailing Address - Phone:716-465-5459
Mailing Address - Fax:
Practice Address - Street 1:432 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-3203
Practice Address - Country:US
Practice Address - Phone:716-856-4530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI54648183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist