Provider Demographics
NPI:1891376828
Name:EWIS, WAFAA
Entity Type:Individual
Prefix:
First Name:WAFAA
Middle Name:
Last Name:EWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 ELM COMMONS DR APT 302201
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1831
Mailing Address - Country:US
Mailing Address - Phone:470-289-9572
Mailing Address - Fax:
Practice Address - Street 1:963 ELM COMMONS DR APT 201
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1815
Practice Address - Country:US
Practice Address - Phone:470-289-9572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT155261835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist