Provider Demographics
NPI:1154802395
Name:KABASIITA, MARTHA (PHARMD)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:KABASIITA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:KABASIITA
Other - Last Name:SEBINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:740 W ALLUVIAL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711
Mailing Address - Country:US
Mailing Address - Phone:800-797-3543
Mailing Address - Fax:
Practice Address - Street 1:740 W ALLUVIAL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711
Practice Address - Country:US
Practice Address - Phone:800-797-3543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-26
Last Update Date:2021-10-13
Deactivation Date:2019-01-17
Deactivation Code:
Reactivation Date:2021-10-07
Provider Licenses
StateLicense IDTaxonomies
CA84560183500000X
CARPH84560183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist