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General NPI Number Information
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NPI Number | 1073240602
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Entity Type | Individual
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Provider Name | HASEEB WAJID PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/03/2022
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 100 E SOUTHLAKE BLVD
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6226
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Country | US
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Telephone | 817-421-2454
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Fax |
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Provider Business Mailing Address
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Address Line | 5704 SPRING VALLEY RD APT 1016
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City | DALLAS
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State | TX
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Zip | 75254-3221
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Country | US
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Telephone | 630-991-8832
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 65894
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License Number State | TX
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