Provider Demographics
NPI:1639513633
Name:WAQAR, TARIQ (BS)
Entity Type:Individual
Prefix:
First Name:TARIQ
Middle Name:
Last Name:WAQAR
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7313 WATERLOO WALK
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-6941
Mailing Address - Country:US
Mailing Address - Phone:615-351-7548
Mailing Address - Fax:
Practice Address - Street 1:7313 WATERLOO WALK
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-6941
Practice Address - Country:US
Practice Address - Phone:615-351-7548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-20
Last Update Date:2013-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19052183500000X
TN0000006830183500000X
DCPH100000768183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLEVEL I PROVIDER TYPMedicaid