Provider Demographics
NPI:1275766784
Name:BASILE, JEANNE CECILE (RPH, PHC)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:CECILE
Last Name:BASILE
Suffix:
Gender:F
Credentials:RPH, PHC
Other - Prefix:MS
Other - First Name:JEANNE
Other - Middle Name:CECILE
Other - Last Name:DOUCETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10701 LOMAS BLVD NE
Mailing Address - Street 2:SUITE 210-B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112
Mailing Address - Country:US
Mailing Address - Phone:505-803-8010
Mailing Address - Fax:505-796-8290
Practice Address - Street 1:10701 LOMAS BLVD NE
Practice Address - Street 2:SUITE 210-B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112
Practice Address - Country:US
Practice Address - Phone:505-803-8010
Practice Address - Fax:505-796-8290
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPC000002751835P0018X
NMRP00004820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist