Provider Demographics
NPI:1063645265
Name:BASSO, PETER L (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:L
Last Name:BASSO
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 COLONIAL WAY
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2757
Mailing Address - Country:US
Mailing Address - Phone:201-715-4926
Mailing Address - Fax:
Practice Address - Street 1:65 JAY ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-3235
Practice Address - Country:US
Practice Address - Phone:201-715-4926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01899400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist