Provider Demographics
NPI:1225632540
Name:WAGHMARE, AMOL PRAKASH
Entity Type:Individual
Prefix:MR
First Name:AMOL
Middle Name:PRAKASH
Last Name:WAGHMARE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 BARRY AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-6616
Mailing Address - Country:US
Mailing Address - Phone:540-250-2451
Mailing Address - Fax:
Practice Address - Street 1:901 SUMNEYTOWN PIKE
Practice Address - Street 2:
Practice Address - City:SPRING HOUSE
Practice Address - State:PA
Practice Address - Zip Code:19477-1008
Practice Address - Country:US
Practice Address - Phone:215-646-5059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441636183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist