Provider Demographics
NPI:1487259016
Name:HABIB, WAHID HARRIS (PHARMD)
Entity type:Individual
Prefix:
First Name:WAHID
Middle Name:HARRIS
Last Name:HABIB
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 SIGNAL PEAK ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-1548
Mailing Address - Country:US
Mailing Address - Phone:858-663-4144
Mailing Address - Fax:
Practice Address - Street 1:4014 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-2011
Practice Address - Country:US
Practice Address - Phone:702-873-5917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22993183500000X
NV19577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist