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General NPI Number Information
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NPI Number | 1174091219
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Entity Type | Organization
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Legal Business Name | WANSS INC
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Dates
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Enumeration Date | 11/07/2018
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Last Update Date | 04/15/2019
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Provider Practice Location Address
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Address Line | 2182 AMSTERDAM AVE
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City | NEW YORK
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State | NY
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Zip | 10032-2433
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Country | US
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Telephone | 646-863-2044
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Fax | 646-863-2085
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Provider Business Mailing Address
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Address Line | 2182 AMSTERDAM AVE
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City | NEW YORK
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State | NY
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Zip | 10032-2433
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Country | US
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Telephone | 646-863-2044
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Fax | 646-863-2085
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Authorized Official
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Title or Position | PHARMACIST
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Name | WALLA MOHAMED
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Credential | PHARM D.
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Telephone | 929-216-6566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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