Provider Demographics
NPI:1235153628
Name:BASSANELL, MICHAEL SLAVA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SLAVA
Last Name:BASSANELL
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 1:6433 99TH ST
Mailing Address - Street 2:APT 1B
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3563
Mailing Address - Country:US
Mailing Address - Phone:718-275-1949
Mailing Address - Fax:
Practice Address - Street 1:11253 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5554
Practice Address - Country:US
Practice Address - Phone:718-575-9482
Practice Address - Fax:718-263-7742
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist