Provider Demographics
NPI:1720343239
Name:KUTBI, HUSSAM IBRAHIM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HUSSAM
Middle Name:IBRAHIM
Last Name:KUTBI
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 1:3300 N PASEO DE LOS RIOS APT 15205
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6089
Mailing Address - Country:US
Mailing Address - Phone:520-626-7903
Mailing Address - Fax:
Practice Address - Street 1:1295 N MARTIN
Practice Address - Street 2:MEDICATION MANAGEMENT CENTER
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-0001
Practice Address - Country:US
Practice Address - Phone:520-626-7903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist