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General NPI Number Information
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NPI Number | 1497180301
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Entity Type | Individual
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Provider Name | RAOUF M BASLIOUS RPH
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Gender | Male
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Dates
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Enumeration Date | 09/10/2013
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Last Update Date | 09/10/2013
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Provider Practice Location Address
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Address Line | 120 E BONITA AVE
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City | SAN DIMAS
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State | CA
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Zip | 91773-3003
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Country | US
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Telephone | 909-305-4888
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Fax |
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Provider Business Mailing Address
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Address Line | 2250 CALLE BELICIA
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City | SAN DIMAS
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State | CA
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Zip | 91773-4464
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Country | US
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Telephone | 909-599-9480
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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 | RPH39233
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License Number State | CA
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