Provider Demographics
NPI:1528668761
Name:CHREITAH, BASSEL
Entity type:Individual
Prefix:
First Name:BASSEL
Middle Name:
Last Name:CHREITAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4331 THOUSAND OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-2101
Mailing Address - Country:US
Mailing Address - Phone:210-591-4979
Mailing Address - Fax:210-591-4980
Practice Address - Street 1:4331 THOUSAND OAKS DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-2101
Practice Address - Country:US
Practice Address - Phone:210-591-4979
Practice Address - Fax:210-591-4980
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist