Provider Demographics
NPI:1427380849
Name:BASDEO, TERRY ANTHONY (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:ANTHONY
Last Name:BASDEO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W CHESTER ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-1915
Mailing Address - Country:US
Mailing Address - Phone:516-705-5673
Mailing Address - Fax:
Practice Address - Street 1:44 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-3817
Practice Address - Country:US
Practice Address - Phone:516-872-6861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049874183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist