Provider Demographics
NPI:1871170159
Name:WASIQUE, SAIRA (RPH)
Entity type:Individual
Prefix:
First Name:SAIRA
Middle Name:
Last Name:WASIQUE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 VISTA GLEN DR APT 4223
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-0273
Mailing Address - Country:US
Mailing Address - Phone:501-960-7632
Mailing Address - Fax:
Practice Address - Street 1:2101 W SPRING CREEK PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-4103
Practice Address - Country:US
Practice Address - Phone:972-943-0601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58574183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist