Provider Demographics
NPI:1639870280
Name:RUNDHAWA, ISHAQ WARIS (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:MR
First Name:ISHAQ
Middle Name:WARIS
Last Name:RUNDHAWA
Suffix:
Gender:M
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235B BOXWOOD RD. APT.207
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403
Mailing Address - Country:US
Mailing Address - Phone:443-995-8087
Mailing Address - Fax:
Practice Address - Street 1:1720 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:MD
Practice Address - Zip Code:21619-2602
Practice Address - Country:US
Practice Address - Phone:410-604-2337
Practice Address - Fax:410-604-3697
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT04195183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician