Provider Demographics
NPI:1285398537
Name:ASHHAB, OMAR (RPH)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:ASHHAB
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 1:25151 BROOKPARK RD APT 208
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3415
Mailing Address - Country:US
Mailing Address - Phone:313-742-5240
Mailing Address - Fax:
Practice Address - Street 1:27120 BAGLEY RD
Practice Address - Street 2:
Practice Address - City:OLMSTED TWP
Practice Address - State:OH
Practice Address - Zip Code:44138-1062
Practice Address - Country:US
Practice Address - Phone:440-235-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-23
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03441244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist