Provider Demographics
NPI:1366802472
Name:RASSAM, WAFFA G (RPH)
Entity type:Individual
Prefix:
First Name:WAFFA
Middle Name:G
Last Name:RASSAM
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 1:4067 LAGNIAPPE WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-1201
Mailing Address - Country:US
Mailing Address - Phone:850-284-2678
Mailing Address - Fax:
Practice Address - Street 1:4067 LAGNIAPPE WAY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32317-1201
Practice Address - Country:US
Practice Address - Phone:850-284-2678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist