Provider Demographics
NPI:1740767870
Name:BASANI, VENKATESHWAR (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:VENKATESHWAR
Middle Name:
Last Name:BASANI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TAMARACK LN
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9844
Mailing Address - Country:US
Mailing Address - Phone:207-671-5939
Mailing Address - Fax:
Practice Address - Street 1:50 BOULDER WAY
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9442
Practice Address - Country:US
Practice Address - Phone:207-286-9562
Practice Address - Fax:207-286-9576
Is Sole Proprietor?:No
Enumeration Date:2018-07-21
Last Update Date:2018-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist