Provider Demographics
NPI:1013564277
Name:ABUKHZAM, EMAD (PHARMD)
Entity Type:Individual
Prefix:
First Name:EMAD
Middle Name:
Last Name:ABUKHZAM
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 1:19007 BEAVERCREEK RD
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-9537
Mailing Address - Country:US
Mailing Address - Phone:503-657-3191
Mailing Address - Fax:
Practice Address - Street 1:19007 BEAVERCREEK RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-9537
Practice Address - Country:US
Practice Address - Phone:503-657-3191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0017399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist