Basic Information
| Provider Information | |||||||||
| NPI: | 1679177992 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WAHI | ||||||||
| FirstName: | MANAV | ||||||||
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| Credential: | PHARM D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 202 W OLD COUNTRY RD | ||||||||
| Address2: | |||||||||
| City: | HICKSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 118014011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164334400 | ||||||||
| FaxNumber: | 5169338043 | ||||||||
| Practice Location | |||||||||
| Address1: | 202 W OLD COUNTRY RD | ||||||||
| Address2: | |||||||||
| City: | HICKSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 118014011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164334400 | ||||||||
| FaxNumber: | 5169338043 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2020 | ||||||||
| LastUpdateDate: | 11/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P0018X | 063098 | NY | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.