Active NPI
Mohammad Ahmed Abu Mallouh, PHARMD
- Pharmacist
- Prineville, OR
National Provider Identifier
1104548288
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH-0018957
- Practice address
- 384 SE Combs Flat Rd
Prineville, OR 97754-2562 - Phone
- (541) 447-8423
- Fax
- (541) 447-8724
- NPI assigned
- Sep 14, 2022
- Last updated
- Sep 14, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH-0018957 | OR | Primary |
Addresses
Primary practice location
384 SE Combs Flat Rd
Prineville, OR 97754-2562
Mailing address
2324 NW Elm Ave
Redmond, OR 97756-7097
Phone (541) 447-8423
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH-0018957 | OR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663113600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663113600000",
"number": "1104548288",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2324 NW ELM AVE",
"city": "REDMOND",
"state": "OR",
"postal_code": "977567097",
"telephone_number": "541-447-8423"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "384 SE COMBS FLAT RD",
"city": "PRINEVILLE",
"state": "OR",
"postal_code": "977542562",
"telephone_number": "541-447-8423",
"fax_number": "541-447-8724"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ABU MALLOUH",
"first_name": "MOHAMMAD",
"middle_name": "AHMED",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-09-14",
"last_updated": "2022-09-14",
"certification_date": "2022-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "RPH-0018957",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prineville, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.