Provider Demographics
NPI:1891048930
Name:SARDAR, MAHMUD ABDULLAH (RPH)
Entity Type:Individual
Prefix:MR
First Name:MAHMUD
Middle Name:ABDULLAH
Last Name:SARDAR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2549 WATSON ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-7130
Mailing Address - Country:US
Mailing Address - Phone:541-882-8863
Mailing Address - Fax:
Practice Address - Street 1:5500 SO 6TH STREET
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-7130
Practice Address - Country:US
Practice Address - Phone:541-882-8863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0009589183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR20-4057706OtherTAX ID