Mia Ajekwu Bassaragh, PHARM.D.

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

19243 Issued in LA

Practice address

3400 Airline Dr.
Bossier City, LA 71111

Phone

(318) 741-6589

NPI assigned

Oct 19, 2010

Last updated

Oct 19, 2010By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Walgreen Co

  dba Walgreens #09998

  • Pharmacy
  • Bossier City, LA
  • NPI 1710994892
  NPD (past)
• Walgreen Co

  dba Walgreens #21605

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287446400000",
    "number": "1073823449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2940 LE OAKS DRIVE #1514",
            "city": "BOSSIER",
            "state": "LA",
            "postal_code": "71111",
            "telephone_number": "281-224-1424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 AIRLINE DR.",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "71111",
            "telephone_number": "318-741-6589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AJEKWU BASSARAGH",
        "first_name": "MIA",
        "name_prefix": "Dr.",
        "credential": "PHARM.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-19",
        "last_updated": "2010-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "LA",
            "license": "19243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hasan Ahmad
• Ahp of Western Louisana, LLC (Anesthesia Healthcare Partners)
• Ahp of Western Louisiana LLC
• Airline Drug LLC (Airline Drug)
• Airline Urgent Care
• Jessica Ann Akbarian-Tefaghi, PHARMD.
• Mary Melissa Albritton, M.D.
• Alexander Timeless Group LLC
• Camelita Alexander
• Mercedes Alexander

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Bossier City, LA
• Providers in Bossier City, LA by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.