Healthcare Provider Details

I. General information

NPI: 1912324583
Provider Name (Legal Business Name): MUHAMMAD A QUDOOS PHARMD, BCGP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

679 MAIN ST
SWEET HOME OR
97386
US

IV. Provider business mailing address

679 MAIN ST
SWEET HOME OR
97386-3305
US

V. Phone/Fax

Practice location:
  • Phone: 541-451-6296
  • Fax:
Mailing address:
  • Phone: 541-451-6296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number54660
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60361537
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH-0014137
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: