Provider Demographics
NPI:1003009002
Name:BASIN, MAYA (RPH)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:BASIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 174TH ST
Mailing Address - Street 2:APT 704
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3323
Mailing Address - Country:US
Mailing Address - Phone:917-359-0977
Mailing Address - Fax:
Practice Address - Street 1:250 174TH ST
Practice Address - Street 2:APT 704
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-3323
Practice Address - Country:US
Practice Address - Phone:917-359-0977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047436183500000X
NJ28RI03417200183500000X
FLPS47269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY047436OtherPHARMACIST
NJ28RI03417200OtherPHARMACIST
FLPS47269OtherPHARMACIST