Healthcare Provider Details

I. General information

NPI: 1114740347
Provider Name (Legal Business Name): ENAS WAHBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 BLACKWELL RD
WARRENTON VA
20186
US

IV. Provider business mailing address

510 BLACKWELL RD
WARRENTON VA
20186-2600
US

V. Phone/Fax

Practice location:
  • Phone: 540-347-1621
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202213662
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: