Healthcare Provider Details

I. General information

NPI: 1851908719
Provider Name (Legal Business Name): SYED WAJID HUSSAIN BUKHARI RPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12510 OCEAN GTWY
OCEAN CITY MD
21842-9690
US

IV. Provider business mailing address

535 WHITE PINE DR
FRUITLAND MD
21826-1946
US

V. Phone/Fax

Practice location:
  • Phone: 410-213-1228
  • Fax:
Mailing address:
  • Phone: 410-845-3723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP27575
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: