Provider Demographics
NPI:1851908719
Name:BUKHARI, SYED WAJID HUSSAIN (RPH)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:WAJID HUSSAIN
Last Name:BUKHARI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 WHITE PINE DR
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21826-1946
Mailing Address - Country:US
Mailing Address - Phone:410-845-3723
Mailing Address - Fax:
Practice Address - Street 1:12510 OCEAN GTWY
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842-9690
Practice Address - Country:US
Practice Address - Phone:410-213-1228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP27575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD27575OtherPHARMACIST