Healthcare Provider Details

I. General information

NPI: 1154802395
Provider Name (Legal Business Name): MARTHA KABASIITA PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARTHA KABASIITA SEBINA

II. Dates (important events)

Enumeration Date: 08/26/2018
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date: 01/17/2019
Reactivation Date: 10/07/2021

III. Provider practice location address

740 W ALLUVIAL AVE SUITE 101
FRESNO CA
93711
US

IV. Provider business mailing address

740 W ALLUVIAL AVE SUITE 101
FRESNO CA
93711
US

V. Phone/Fax

Practice location:
  • Phone: 800-797-3543
  • Fax:
Mailing address:
  • Phone: 800-797-3543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number84560
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH84560
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: