Provider Demographics
NPI:1699299198
Name:OSMAN, SALAH
Entity type:Individual
Prefix:MR
First Name:SALAH
Middle Name:
Last Name:OSMAN
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 1:2840 N DYSART RD
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2338
Mailing Address - Country:US
Mailing Address - Phone:623-536-5309
Mailing Address - Fax:
Practice Address - Street 1:2840 N DYSART RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2338
Practice Address - Country:US
Practice Address - Phone:623-536-5309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-27
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENAOtherNOT APPLICABLE