Provider Demographics
NPI:1861145591
Name:CHUDHRY, ABDUL
Entity type:Individual
Prefix:MR
First Name:ABDUL
Middle Name:
Last Name:CHUDHRY
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 1:25880 OUTER DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-1553
Mailing Address - Country:US
Mailing Address - Phone:734-502-4293
Mailing Address - Fax:
Practice Address - Street 1:25880 OUTER DR
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-1553
Practice Address - Country:US
Practice Address - Phone:313-633-0021
Practice Address - Fax:303-633-0429
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035635183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist