Provider Demographics
NPI:1902353287
Name:ALMULLA, AHMAD
Entity Type:Individual
Prefix:MR
First Name:AHMAD
Middle Name:
Last Name:ALMULLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 NEVIN AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-3143
Mailing Address - Country:US
Mailing Address - Phone:510-307-3188
Mailing Address - Fax:510-307-1947
Practice Address - Street 1:2148 BLUEROCK CIR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-1670
Practice Address - Country:US
Practice Address - Phone:925-951-3155
Practice Address - Fax:510-307-1947
Is Sole Proprietor?:No
Enumeration Date:2016-09-05
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA701801835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA941059121OtherCVS