Provider Demographics
NPI:1578870366
Name:HENEIN, BASSEM NABIL HABIB (RPH)
Entity Type:Individual
Prefix:
First Name:BASSEM
Middle Name:NABIL HABIB
Last Name:HENEIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10357 MATTOCK AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3004
Mailing Address - Country:US
Mailing Address - Phone:562-480-8254
Mailing Address - Fax:
Practice Address - Street 1:1534 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001-2536
Practice Address - Country:US
Practice Address - Phone:323-587-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist