Provider Demographics
NPI:1144895038
Name:BASTA, SARAH ELIZABETH (PHARMD BCGP)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:ELIZABETH
Last Name:BASTA
Suffix:
Gender:F
Credentials:PHARMD BCGP
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:ELIZABETH
Other - Last Name:BASIAGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD BCGP
Mailing Address - Street 1:40 COLONIAL HTS
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-7907
Mailing Address - Country:US
Mailing Address - Phone:860-655-7663
Mailing Address - Fax:
Practice Address - Street 1:839 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-6006
Practice Address - Country:US
Practice Address - Phone:203-235-8285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist