Provider Demographics
NPI:1801485057
Name:OUDEH, MUSTAFA (PHARMD)
Entity type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:
Last Name:OUDEH
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 1:4309 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-5117
Mailing Address - Country:US
Mailing Address - Phone:863-399-8791
Mailing Address - Fax:
Practice Address - Street 1:4309 NEW BERN AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1445
Practice Address - Country:US
Practice Address - Phone:919-231-2858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist