Provider Demographics
NPI:1912324583
Name:QUDOOS, MUHAMMAD A (PHARMD, BCGP)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:A
Last Name:QUDOOS
Suffix:
Gender:M
Credentials:PHARMD, BCGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SWEET HOME
Mailing Address - State:OR
Mailing Address - Zip Code:97386-3305
Mailing Address - Country:US
Mailing Address - Phone:541-451-6296
Mailing Address - Fax:
Practice Address - Street 1:679 MAIN ST
Practice Address - Street 2:
Practice Address - City:SWEET HOME
Practice Address - State:OR
Practice Address - Zip Code:97386
Practice Address - Country:US
Practice Address - Phone:541-451-6296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-21
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54660183500000X
WAPH60361537183500000X
ORRPH-00141371835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist