Provider Demographics
NPI:1205301520
Name:BASSO PHARMACY, INC.
Entity type:Organization
Organization Name:BASSO PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALIBANAEI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:818-347-1645
Mailing Address - Street 1:PO BOX 2248
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91376-2248
Mailing Address - Country:US
Mailing Address - Phone:818-347-1645
Mailing Address - Fax:818-347-5712
Practice Address - Street 1:28880 MICHELLE DR
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-2131
Practice Address - Country:US
Practice Address - Phone:818-634-4198
Practice Address - Fax:818-436-0518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-13
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherWORKERS COMPENSATION