Provider Demographics
NPI:1164896098
Name:WAMAITHA, PATRICK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:WAMAITHA
Suffix:
Gender:M
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:PO BOX 3146
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01613-3146
Mailing Address - Country:US
Mailing Address - Phone:508-410-3432
Mailing Address - Fax:
Practice Address - Street 1:3990 E LUCAS DR
Practice Address - Street 2:#1725
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77708-5513
Practice Address - Country:US
Practice Address - Phone:409-898-2990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53760183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist