Provider Demographics
NPI:1770872202
Name:BASSERI, YASHAR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:YASHAR
Middle Name:
Last Name:BASSERI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3437 GREEN PINE LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-5902
Mailing Address - Country:US
Mailing Address - Phone:757-340-5374
Mailing Address - Fax:
Practice Address - Street 1:5232 FAIRFIELD SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4212
Practice Address - Country:US
Practice Address - Phone:757-495-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210098183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist