Provider Demographics
NPI:1588860266
Name:WASO HEALTHCARE LLC
Entity Type:Organization
Organization Name:WASO HEALTHCARE LLC
Other - Org Name:MIDDLETOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER,AO
Authorized Official - Prefix:
Authorized Official - First Name:WAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALIFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-705-6252
Mailing Address - Street 1:4421 ROOSEVELT BLVD
Mailing Address - Street 2:STE H
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-9023
Mailing Address - Country:US
Mailing Address - Phone:513-705-6252
Mailing Address - Fax:513-705-6253
Practice Address - Street 1:4421 ROOSEVELT BLVD
Practice Address - Street 2:STE H
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-9023
Practice Address - Country:US
Practice Address - Phone:513-705-6252
Practice Address - Fax:513-705-6253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
OH022266503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1822487Medicaid
2135001OtherPK