Provider Demographics
NPI:1770458283
Name:BUKSH, MOHAMMED S
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:S
Last Name:BUKSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 VAN LAYDEN WAY # A
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-2455
Mailing Address - Country:US
Mailing Address - Phone:209-505-7718
Mailing Address - Fax:
Practice Address - Street 1:2075 E HATCH RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-5149
Practice Address - Country:US
Practice Address - Phone:209-537-4824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-07
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91542183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist