Healthcare Provider Details

I. General information

NPI: 1639870280
Provider Name (Legal Business Name): ISHAQ WARIS RUNDHAWA PHARMACY TECHNICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 MAIN ST
CHESTER MD
21619-2602
US

IV. Provider business mailing address

235B BOXWOOD RD. APT.207
ANNAPOLIS MD
21403
US

V. Phone/Fax

Practice location:
  • Phone: 410-604-2337
  • Fax: 410-604-3697
Mailing address:
  • Phone: 443-995-8087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberT04195
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: