Healthcare Provider Details

I. General information

NPI: 1366006546
Provider Name (Legal Business Name): ADNAN WAHEED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E BROADWAY
COUNCIL BLUFFS IA
51503-4419
US

IV. Provider business mailing address

535 E BROADWAY
COUNCIL BLUFFS IA
51503-4419
US

V. Phone/Fax

Practice location:
  • Phone: 712-329-0930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22886
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: