Provider Demographics
NPI:1255190047
Name:ALCHALABI, WAFAA AMEED
Entity type:Individual
Prefix:
First Name:WAFAA
Middle Name:AMEED
Last Name:ALCHALABI
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 1:2505 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-1348
Mailing Address - Country:US
Mailing Address - Phone:916-585-2476
Mailing Address - Fax:
Practice Address - Street 1:2505 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-1348
Practice Address - Country:US
Practice Address - Phone:916-585-2476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73788183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist