MEDICARE: MR. MARCEL SASSOLA III RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH40870	CA

General Provider Information

NPI Number	:	1720806953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARCEL SASSOLA III RPH

Provider Business Mailing Address
First Line	:	5018 READ RD
Second Line	:
City	:	MOORPARK
State	:	CA
Zip	:	93021-8765
Country	:	US
Telephone Number	:	818-388-9080
Fax Number	:	866-496-5915

Provider Business Practice Location Address
First Line	:	2946 DE LA VINA ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-3310
Country	:	US
Telephone Number	:	805-967-9990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2024
Last Update Date	:	10/29/2024

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