Healthcare Provider Details

I. General information

NPI: 1790402550
Provider Name (Legal Business Name): WAQAR HAIDER SHAH PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/24/2022
Certification Date: 10/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2962 SAINT LAWRENCE AVE
READING PA
19606-2233
US

IV. Provider business mailing address

108 ATLANTIC AVE
SINKING SPRING PA
19608-9343
US

V. Phone/Fax

Practice location:
  • Phone: 610-779-3120
  • Fax:
Mailing address:
  • Phone: 610-780-2304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP438695
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: