Healthcare Provider Details

I. General information

NPI: 1750531232
Provider Name (Legal Business Name): OLIVIER A WAMAIN PHARMD, PHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2008
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 W VALENCIA RD
TUCSON AZ
85746-6001
US

IV. Provider business mailing address

4730 E GRANT RD
TUCSON AZ
85712-2703
US

V. Phone/Fax

Practice location:
  • Phone: 520-330-3863
  • Fax: 520-573-3930
Mailing address:
  • Phone: 520-330-3863
  • Fax: 520-573-3930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPC00000166
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS0202478
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007260
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: