Provider Demographics
NPI:1063537314
Name:BASSEK, ROLAND E (PHARMACIST)
Entity type:Individual
Prefix:
First Name:ROLAND
Middle Name:E
Last Name:BASSEK
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 OLIVINE CT
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-5206
Mailing Address - Country:US
Mailing Address - Phone:760-815-7076
Mailing Address - Fax:
Practice Address - Street 1:1995 OLIVINE CT
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-5206
Practice Address - Country:US
Practice Address - Phone:760-815-7076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45448183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist