Provider Demographics
NPI:1902654353
Name:BASAGOITIA, ANDREA INES (BPHARM, PHD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:INES
Last Name:BASAGOITIA
Suffix:
Gender:F
Credentials:BPHARM, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 LAGUNA CT
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-9514
Mailing Address - Country:US
Mailing Address - Phone:209-600-1567
Mailing Address - Fax:
Practice Address - Street 1:48 ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:CHOWCHILLA
Practice Address - State:CA
Practice Address - Zip Code:93610-2928
Practice Address - Country:US
Practice Address - Phone:559-665-1096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH89557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH89557OtherCALIFORNIA BOARD OF PHARMACY