Provider Demographics
NPI:1073729927
Name:CASSEL, CLYDE (R PH)
Entity Type:Individual
Prefix:MR
First Name:CLYDE
Middle Name:
Last Name:CASSEL
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 E CARSON ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2720
Mailing Address - Country:US
Mailing Address - Phone:310-597-6991
Mailing Address - Fax:310-830-2979
Practice Address - Street 1:645 E CARSON ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-2720
Practice Address - Country:US
Practice Address - Phone:310-597-6991
Practice Address - Fax:310-830-2979
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35717183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist