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General NPI Number Information
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NPI Number | 1235153628
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Entity Type | Individual
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Provider Name | MICHAEL SLAVA BASSANELL PHARM D
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Gender | Male
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 11/30/2008
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Provider Practice Location Address
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Address Line | 11253 QUEENS BLVD
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City | FOREST HILLS
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State | NY
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Zip | 11375-5554
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Country | US
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Telephone | 718-575-9482
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Fax | 718-263-7742
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Provider Business Mailing Address
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Address Line | 6433 99TH ST APT 1B
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City | REGO PARK
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State | NY
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Zip | 11374-3563
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Country | US
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Telephone | 718-275-1949
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 049875
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License Number State | NY
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