Provider Demographics
NPI:1902426034
Name:OMAR, YAHIA ABDO (RPH)
Entity type:Individual
Prefix:
First Name:YAHIA
Middle Name:ABDO
Last Name:OMAR
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 1:6334 STEADMAN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2064
Mailing Address - Country:US
Mailing Address - Phone:313-595-6130
Mailing Address - Fax:
Practice Address - Street 1:32131 INDUSTRIAL RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1836
Practice Address - Country:US
Practice Address - Phone:734-762-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-18
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315112090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIO560947029447OtherSECRETARY OF STATE DL