Provider Demographics
NPI:1093728594
Name:BASILE, JEFFREY SALVATORE (BACHLORS OF PHARMACY)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:SALVATORE
Last Name:BASILE
Suffix:
Gender:M
Credentials:BACHLORS OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-3115
Mailing Address - Country:US
Mailing Address - Phone:201-438-5768
Mailing Address - Fax:
Practice Address - Street 1:646 7TH ST
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-3115
Practice Address - Country:US
Practice Address - Phone:201-438-5768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02828200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist