1740593409 NPI number — DR. SYLVESTER A OSA-IYARE PHARMD

Table of content: DR. SYLVESTER A OSA-IYARE PHARMD (NPI 1740593409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740593409 NPI number — DR. SYLVESTER A OSA-IYARE PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSA-IYARE
Provider First Name:
SYLVESTER
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740593409
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22402 BELLAIRE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77407-3903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-202-0345
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 US ROUTE 1 STE 1
Provider Second Line Business Practice Location Address:
RITE AID PHARMACY
Provider Business Practice Location Address City Name:
BUCKSPORT
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-469-2201
Provider Business Practice Location Address Fax Number:
207-469-6803
Provider Enumeration Date:
07/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PR5744 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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