Provider Demographics
NPI:1578099065
Name:WAQAS, MUHAMMAD (PHARM D)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:
Last Name:WAQAS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 BEECHER AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-1204
Mailing Address - Country:US
Mailing Address - Phone:631-355-1627
Mailing Address - Fax:
Practice Address - Street 1:4561 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-4603
Practice Address - Country:US
Practice Address - Phone:631-567-1061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061274183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist