Provider Demographics
NPI:1831794460
Name:KAMAL, OSAMA MATTA (RPH)
Entity type:Individual
Prefix:
First Name:OSAMA
Middle Name:MATTA
Last Name:KAMAL
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 1:4701 S FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330-2312
Mailing Address - Country:US
Mailing Address - Phone:954-434-3160
Mailing Address - Fax:954-434-3122
Practice Address - Street 1:4701 S FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33330-2312
Practice Address - Country:US
Practice Address - Phone:954-434-3160
Practice Address - Fax:954-434-3122
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist