Provider Demographics
NPI:1669754529
Name:FAHMY, WAFIK NASRI (RPH)
Entity type:Individual
Prefix:MR
First Name:WAFIK
Middle Name:NASRI
Last Name:FAHMY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-3753
Mailing Address - Country:US
Mailing Address - Phone:805-614-4667
Mailing Address - Fax:805-614-4087
Practice Address - Street 1:707 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-3753
Practice Address - Country:US
Practice Address - Phone:805-614-4667
Practice Address - Fax:805-614-4087
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH32554183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH 32554OtherPAHRMACIST LICENSE