| Doctor Name: | DR. MIA AJEKWU BASSARAGH |
| NPI Number: | 1073823449 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHARM.D. |
| License Number: | 19243 |
| Business Practice Address: | 3400 Airline Dr. Bossier City, LA - 71111 |
| Business Phone Number: | 3187416589 |
| Business Fax Number: | |
| Mailing Address: | 2940 Le Oaks Drive #1514, BOSSIER |
| State: | LA |
| Postal Code: | 71111 |
| Phone Number: | 2812241424 |
| Fax Number: | |
| NPI Enumeration Date: | 10/19/2010 |
| NPI Last Update Date: | 10/19/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1835P0018X |
| License Number: | 19243 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacist |
| Taxonomy Specialization: | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| Taxonomy Definition: | Pharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescriptive authority, therapeutic management, and disease management. |