Provider Demographics
NPI:1144407776
Name:BACHINSKY, MARC (RPH)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:BACHINSKY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 ROUTE 112
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-2551
Mailing Address - Country:US
Mailing Address - Phone:631-475-4476
Mailing Address - Fax:
Practice Address - Street 1:72 BAYVILLE AVE
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11709-1656
Practice Address - Country:US
Practice Address - Phone:516-628-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027367183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist