Provider Demographics
NPI:1134984966
Name:BEDASO, MOHAMMED TUSSE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:TUSSE
Last Name:BEDASO
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 1:6035 N DAMEN AVE APT 309
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4353
Mailing Address - Country:US
Mailing Address - Phone:773-742-8701
Mailing Address - Fax:
Practice Address - Street 1:516 S LOOMIS ST.,
Practice Address - Street 2:PHARMACY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607
Practice Address - Country:US
Practice Address - Phone:773-742-8701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0512923971835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist