Individual
KELLY BASL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1535 N 1ST ST, STAYTON, OR 97383-1213
(503) 769-5345
Mailing address
1535 N 1ST ST, STAYTON, OR 97383-1213
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
9670
OR
Other
Enumeration date
10/31/2010
Last updated
10/31/2010
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