Provider Demographics
NPI:1457955783
Name:SEVERINO, OMAR PAOLO (PHARMD)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:PAOLO
Last Name:SEVERINO
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 1:203 HULL ST APT 3D
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-4274
Mailing Address - Country:US
Mailing Address - Phone:954-247-1311
Mailing Address - Fax:
Practice Address - Street 1:2924 CHAMBERLAYNE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-3506
Practice Address - Country:US
Practice Address - Phone:804-321-7068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202219262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist