Organization
BASSO PHARMACY, INC.
Active
Other names
GOLD COAST PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALIREZA ALIBANAEI RPH (PRESIDENT/PIC)
(805) 242-4575
Entity
Organization
Contact information
Practice address
552 SESPE AVE, FILLMORE, CA 93015-1957
(805) 242-4575
(805) 242-4505
Mailing address
552 SESPE AVE, FILLMORE, CA 93015-1957
(805) 242-4575
(805) 242-4505
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
57740
BOARD OF PHARMACY PERMIT
CA
Enumeration date
06/22/2020
Last updated
06/22/2020
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