Provider Demographics
NPI:1922463884
Name:WAWERU, NOREEN
Entity Type:Individual
Prefix:
First Name:NOREEN
Middle Name:
Last Name:WAWERU
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 1:101 W UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-1809
Mailing Address - Country:US
Mailing Address - Phone:508-615-7215
Mailing Address - Fax:
Practice Address - Street 1:350 E VISTA RIDGE MALL DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4072
Practice Address - Country:US
Practice Address - Phone:508-615-7215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-20
Last Update Date:2015-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54126183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist