Provider Demographics
NPI:1770182974
Name:BASHAEWUTH, ABDUL (PHARMD)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:
Last Name:BASHAEWUTH
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 1:9165 CAHILL AVE
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-3542
Mailing Address - Country:US
Mailing Address - Phone:651-451-7860
Mailing Address - Fax:651-451-7862
Practice Address - Street 1:9165 CAHILL AVE
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-3542
Practice Address - Country:US
Practice Address - Phone:651-451-7860
Practice Address - Fax:651-451-7862
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN151860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist