Provider Demographics
NPI:1750531232
Name:WAMAIN, OLIVIER A (PHARMD, PHC)
Entity type:Individual
Prefix:DR
First Name:OLIVIER
Middle Name:A
Last Name:WAMAIN
Suffix:
Gender:M
Credentials:PHARMD, PHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20414 N 27TH AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-3252
Mailing Address - Country:US
Mailing Address - Phone:623-707-0033
Mailing Address - Fax:
Practice Address - Street 1:12602 N PARADISE VILLAGE PKWY W
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-7671
Practice Address - Country:US
Practice Address - Phone:602-953-0253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007260183500000X
NMPC000001661835P0018X
AZS0202478183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist