Mohammad Ahmed Abu Mallouh, PHARMD
Individual provider Active NPI Pharmacist · Prineville, OR
NPI 1104548288 · NPPES record last updated Sep 14, 2022
Key facts
- NPI
- 1104548288
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- RPH-0018957 (OR)
- Practice address
- 384 SE Combs Flat Rd
Prineville, OR 97754-2562 - Phone
- (541) 447-8423
- Fax
- (541) 447-8724
- NPI assigned
- Sep 14, 2022
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH-0018957 | OR | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH-0018957 | OR | Yes |
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
Other providers in Prineville, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 14, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.