Provider Demographics
NPI:1689959157
Name:BAWARSKI, WILLIE
Entity Type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:
Last Name:BAWARSKI
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 1:900 N RANCHO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-1005
Mailing Address - Country:US
Mailing Address - Phone:315-527-9838
Mailing Address - Fax:702-646-5987
Practice Address - Street 1:4620 DREAM CATCHER AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-5354
Practice Address - Country:US
Practice Address - Phone:315-527-9838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17952183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist