Provider Demographics
NPI:1336373471
Name:ABDULWAHAB, TUTUGN T (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TUTUGN
Middle Name:T
Last Name:ABDULWAHAB
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5992 BROOKSIDE OAK CIR
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-1752
Mailing Address - Country:US
Mailing Address - Phone:404-399-4813
Mailing Address - Fax:770-416-0114
Practice Address - Street 1:5992 BROOKSIDE OAK CIR
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1752
Practice Address - Country:US
Practice Address - Phone:404-399-4813
Practice Address - Fax:770-416-0114
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist