Provider Demographics
NPI:1629585443
Name:BUSOLO, SELINE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SELINE
Middle Name:
Last Name:BUSOLO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 W REDLANDS BLVD
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-6228
Mailing Address - Country:US
Mailing Address - Phone:909-792-6260
Mailing Address - Fax:909-798-6672
Practice Address - Street 1:2050 W REDLANDS BLVD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-6228
Practice Address - Country:US
Practice Address - Phone:909-792-6260
Practice Address - Fax:909-798-6672
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61091183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist