Active NPI
Omar M Awadalla, PHARM.D
- Pharmacist
- Valley Stream, NY
National Provider Identifier
1649724162
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 062101
- Practice address
- 138 Rockaway Ave
Valley Stream, NY 11580-5813 - Phone
- (516) 612-9300
- Fax
- (855) 777-8254
- NPI assigned
- Aug 12, 2016
- Last updated
- Feb 26, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 062101 | NY | Primary |
Addresses
Primary practice location
138 Rockaway Ave
Valley Stream, NY 11580-5813
Mailing address
138 Rockaway Ave
Valley Stream, NY 11580-5813
Phone (516) 612-9300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05446837 | Medicaid | NY |
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 062101 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sublime Drugs Inc | Current | Accepting new patients | |
| Beso Pharmacy Inc | Current | Accepting new patients | |
| Expert Pharmacy Inc. | Past | Accepting new patients | |
| Dna Pharmacy Inc. | Past | Accepting new patients |
Locations
138 Rockaway Ave
Valley Stream, NY 11580
Phone (516) 612-9300
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- Pharmacy
- Richmond Hill, NY
- NPI 1124667811
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1470960000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708905600000",
"number": "1649724162",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "138 ROCKAWAY AVE",
"city": "VALLEY STREAM",
"state": "NY",
"postal_code": "115805813",
"telephone_number": "516-612-9300",
"fax_number": "855-777-8254"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "138 ROCKAWAY AVE",
"city": "VALLEY STREAM",
"state": "NY",
"postal_code": "115805813",
"telephone_number": "516-612-9300",
"fax_number": "855-777-8254"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AWADALLA",
"first_name": "OMAR",
"middle_name": "M",
"credential": "PHARM.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-08-12",
"last_updated": "2024-02-26",
"certification_date": "2024-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "062101",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "05446837",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Valley Stream, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 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.