MEDICARE: SHABNAM WAHID PHARMD

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	PS50493	FL

General Provider Information

NPI Number	:	1073472080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHABNAM WAHID PHARMD

Provider Business Mailing Address
First Line	:	1533 WESTWIND DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32250-2587
Country	:	US
Telephone Number	:	904-333-5139
Fax Number	:

Provider Business Practice Location Address
First Line	:	1533 WESTWIND DR
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-2587
Country	:	US
Telephone Number	:	904-333-5139
Fax Number	:

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

Provider Enumeration Date	:	01/16/2026
Last Update Date	:	01/16/2026

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