Provider Demographics
NPI:1710990379
Name:WAFA, NORWAN MOALEJI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NORWAN
Middle Name:MOALEJI
Last Name:WAFA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:NORWAN
Other - Middle Name:JAMILLA
Other - Last Name:MOALEJI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:11301 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90073-1003
Mailing Address - Country:US
Mailing Address - Phone:310-478-3711
Mailing Address - Fax:310-268-4272
Practice Address - Street 1:11301 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:310-268-4272
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO159671835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
406007782OtherBPS