Provider Demographics
NPI:1245574474
Name:WASEF, MINA
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:WASEF
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 1:4000 MAIDSTONE DR APT 48
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-5694
Mailing Address - Country:US
Mailing Address - Phone:315-561-9921
Mailing Address - Fax:
Practice Address - Street 1:4000 MAIDSTONE DR APT 48
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-5694
Practice Address - Country:US
Practice Address - Phone:315-561-9921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist