Provider Demographics
NPI:1033499033
Name:BASLE, JACILYN ANNE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JACILYN
Middle Name:ANNE
Last Name:BASLE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 ULSTER AVE
Mailing Address - Street 2:SUITE 227
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-1501
Mailing Address - Country:US
Mailing Address - Phone:845-336-6030
Mailing Address - Fax:845-336-6030
Practice Address - Street 1:1300 ULSTER AVE
Practice Address - Street 2:SUITE 227
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-1501
Practice Address - Country:US
Practice Address - Phone:845-336-6030
Practice Address - Fax:845-336-6030
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist