Provider Demographics
NPI:1558531277
Name:BASINI, EUGENE CHARLES (RPH)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:CHARLES
Last Name:BASINI
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 1:1035 STRAIGHT PATH
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-3246
Mailing Address - Country:US
Mailing Address - Phone:631-888-0750
Mailing Address - Fax:631-888-0750
Practice Address - Street 1:1035 STRAIGHT PATH
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-3246
Practice Address - Country:US
Practice Address - Phone:631-888-0750
Practice Address - Fax:631-888-0750
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist