Provider Demographics
NPI:1114734928
Name:ROSHDY, OMAR
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:ROSHDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-2558
Mailing Address - Country:US
Mailing Address - Phone:850-265-5640
Mailing Address - Fax:850-265-5640
Practice Address - Street 1:1317 OHIO AVE
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-2558
Practice Address - Country:US
Practice Address - Phone:850-265-5640
Practice Address - Fax:850-265-5640
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSI43917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist