Provider Demographics
NPI:1710310503
Name:WATTAMWAR, AMEET (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:AMEET
Middle Name:
Last Name:WATTAMWAR
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 1:26 IRVING DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-1333
Mailing Address - Country:US
Mailing Address - Phone:516-317-5949
Mailing Address - Fax:
Practice Address - Street 1:26 IRVING DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-1333
Practice Address - Country:US
Practice Address - Phone:516-317-5949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH- 28711835P0018X
NY057657-11835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist