Healthcare Provider Details

I. General information

NPI: 1972873255
Provider Name (Legal Business Name): MALIHA BASIR QUDUS PHARM. D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 W F ST
OAKDALE CA
95361-3837
US

IV. Provider business mailing address

2929 FLOYD AVE APT 269
MODESTO CA
95355-8774
US

V. Phone/Fax

Practice location:
  • Phone: 209-845-2820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number54835
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: