Individual provider Active NPI

Omar Roshdy

  • Pharmacist
  • Lynn Haven, FL
National Provider Identifier
1114734928
Registry record updated Dec 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PSI43917 Issued in FL
Practice address
1317 Ohio Ave
Lynn Haven, FL 32444-2558
Phone
(850) 265-5640
Fax
(850) 265-5640
NPI assigned
Dec 16, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PSI43917 FL Primary

Addresses

Primary practice location

1317 Ohio Ave
Lynn Haven, FL 32444-2558

Mailing address

1317 Ohio Ave
Lynn Haven, FL 32444-2558
Phone (850) 265-5640

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PSI43917FLMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Holiday CVS LLC PastSince Dec 22, 2024 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1734307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734307200000",
    "number": "1114734928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1317 OHIO AVE",
            "city": "LYNN HAVEN",
            "state": "FL",
            "postal_code": "324442558",
            "telephone_number": "850-265-5640",
            "fax_number": "850-265-5640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1317 OHIO AVE",
            "city": "LYNN HAVEN",
            "state": "FL",
            "postal_code": "324442558",
            "telephone_number": "850-265-5640",
            "fax_number": "850-265-5640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSHDY",
        "first_name": "OMAR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-12-16",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PSI43917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynn Haven, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.