Provider Demographics
NPI:1871691089
Name:AMIR, WASIM
Entity Type:Individual
Prefix:MR
First Name:WASIM
Middle Name:
Last Name:AMIR
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 1:12085 SOMERSET AVE
Mailing Address - Street 2:#5
Mailing Address - City:PRINCESS ANNE
Mailing Address - State:MD
Mailing Address - Zip Code:21853-1314
Mailing Address - Country:US
Mailing Address - Phone:410-651-3980
Mailing Address - Fax:410-651-3985
Practice Address - Street 1:12085 SOMERSET AVE
Practice Address - Street 2:#5
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853-1314
Practice Address - Country:US
Practice Address - Phone:410-651-3980
Practice Address - Fax:410-651-3985
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15332183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD15332OtherPHARMACIST LICENSE