Provider Demographics
NPI:1720650799
Name:WAHBA, NADER KAMAL
Entity Type:Individual
Prefix:
First Name:NADER
Middle Name:KAMAL
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 1:1735 REDWOOD GROVE TER
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4417
Mailing Address - Country:US
Mailing Address - Phone:407-430-3585
Mailing Address - Fax:
Practice Address - Street 1:18915 US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6735
Practice Address - Country:US
Practice Address - Phone:352-357-0768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-10
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS62427183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist