Provider Demographics
NPI:1205431467
Name:WAHBA, EMAD Z
Entity type:Individual
Prefix:
First Name:EMAD
Middle Name:Z
Last Name:WAHBA
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:CVS PHARMACY
Mailing Address - Street 2:15 I ST SE
Mailing Address - City:WASHIGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003
Mailing Address - Country:US
Mailing Address - Phone:202-572-5575
Mailing Address - Fax:202-790-6082
Practice Address - Street 1:CVS PHARMACY
Practice Address - Street 2:15 I ST SE
Practice Address - City:WASHIGTON
Practice Address - State:DC
Practice Address - Zip Code:20003
Practice Address - Country:US
Practice Address - Phone:202-572-5575
Practice Address - Fax:202-790-6082
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH100000665183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist