Provider Demographics
NPI:1033493085
Name:KOMAK, WAGMA (PHARMD)
Entity Type:Individual
Prefix:
First Name:WAGMA
Middle Name:
Last Name:KOMAK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8021 N COLTRANE LN
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-7327
Mailing Address - Country:US
Mailing Address - Phone:520-991-1466
Mailing Address - Fax:
Practice Address - Street 1:3675 E BRITANNIA DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706-5041
Practice Address - Country:US
Practice Address - Phone:520-209-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016372183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist