MEDICARE: MINA WASIF 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	72080	CA
2	183500000X	Pharmacist	23545	NC

General Provider Information

NPI Number	:	1487096681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINA WASIF PHARMD

Provider Business Mailing Address
First Line	:	6500 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4920
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6500 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4920
Country	:	US
Telephone Number	:	310-385-3376
Fax Number	:

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

Provider Enumeration Date	:	07/29/2013
Last Update Date	:	11/26/2018

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Directions to “ MINA WASIF PHARMD” Practice Location

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