Provider Demographics
NPI:1225751910
Name:AGBASSI, MICHAEL JEAN OLIVIER (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JEAN OLIVIER
Last Name:AGBASSI
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 ALAMO WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-6515
Mailing Address - Country:US
Mailing Address - Phone:617-642-8310
Mailing Address - Fax:
Practice Address - Street 1:8831 VILLA LA JOLLA DR
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1949
Practice Address - Country:US
Practice Address - Phone:858-457-4480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist