Provider Demographics
NPI:1245947936
Name:QUTTAS, AGAIBY GAD (RPH)
Entity type:Individual
Prefix:
First Name:AGAIBY
Middle Name:GAD
Last Name:QUTTAS
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 1:77 QUAKER MEETING HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-5103
Mailing Address - Country:US
Mailing Address - Phone:508-477-2655
Mailing Address - Fax:
Practice Address - Street 1:77 QUAKER MEETING HOUSE RD
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-5103
Practice Address - Country:US
Practice Address - Phone:508-477-2655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist