MEDICARE: MR. PARTHIV WAGHWALA R.PH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	34569	TX

General Provider Information

NPI Number	:	1023346129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PARTHIV WAGHWALA R.PH

Provider Business Mailing Address
First Line	:	156 F.M. 518 ROAD
Second Line	:
City	:	KEMAH
State	:	TX
Zip	:	77565
Country	:	US
Telephone Number	:	281-538-3989
Fax Number	:

Provider Business Practice Location Address
First Line	:	156 FM 518 RD
Second Line	:
City	:	KEMAH
State	:	TX
Zip	:	77565-3215
Country	:	US
Telephone Number	:	281-538-3989
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2009
Last Update Date	:	12/01/2009

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