Provider Demographics
NPI:1700255270
Name:AL-OTOUM, MOHAMMED (PHARMD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:AL-OTOUM
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 1:1412 STARVIEW CT
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1614
Mailing Address - Country:US
Mailing Address - Phone:209-922-8661
Mailing Address - Fax:
Practice Address - Street 1:1412 STARVIEW CT
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1614
Practice Address - Country:US
Practice Address - Phone:209-922-8661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2021-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23034183500000X
CA59559183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist