Provider Demographics
NPI:1407909856
Name:BAISLEY PHARMACY INC.
Entity Type:Organization
Organization Name:BAISLEY PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAUD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSARI
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:516-374-2930
Mailing Address - Street 1:16570 BAISLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-2517
Mailing Address - Country:US
Mailing Address - Phone:718-528-2246
Mailing Address - Fax:718-527-0460
Practice Address - Street 1:16570 BAISLEY BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-2517
Practice Address - Country:US
Practice Address - Phone:718-528-2246
Practice Address - Fax:718-527-0406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039031183500000X
NY0211753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01281025Medicaid
NY4674410001Medicare NSC