Provider Demographics
NPI:1518362045
Name:BASSILY, FADY FARID FOUAD
Entity Type:Individual
Prefix:
First Name:FADY
Middle Name:FARID FOUAD
Last Name:BASSILY
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 1:16816 YUKON AVE APT A
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-2027
Mailing Address - Country:US
Mailing Address - Phone:310-621-9678
Mailing Address - Fax:
Practice Address - Street 1:16816 YUKON AVE APT A
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-2027
Practice Address - Country:US
Practice Address - Phone:310-621-9678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70849183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist