Provider Demographics
NPI:1790184521
Name:BASKO, ORSEJDA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ORSEJDA
Middle Name:
Last Name:BASKO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 W RASCHER AVE
Mailing Address - Street 2:APT 1B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2242
Mailing Address - Country:US
Mailing Address - Phone:312-451-6079
Mailing Address - Fax:
Practice Address - Street 1:2545 W RASCHER AVE
Practice Address - Street 2:APT 1B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2242
Practice Address - Country:US
Practice Address - Phone:312-451-6079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL049194101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist