Provider Demographics
NPI:1225352016
Name:WAQAR, MOHAMMAD JAMIL (RPH)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:JAMIL
Last Name:WAQAR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ALLEY POND CT
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5874
Mailing Address - Country:US
Mailing Address - Phone:516-353-8984
Mailing Address - Fax:631-364-1267
Practice Address - Street 1:11 ALLEY POND CT
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5874
Practice Address - Country:US
Practice Address - Phone:516-353-8984
Practice Address - Fax:631-367-1266
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32054183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist