Provider Demographics
NPI:1790385557
Name:BASILE, ERIN KRISTEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:KRISTEN
Last Name:BASILE
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 1:119 CANTIS HILLTOP VILLAS
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-3975
Mailing Address - Country:US
Mailing Address - Phone:859-940-7197
Mailing Address - Fax:
Practice Address - Street 1:5045 UNIVERSITY TOWN CENTRE DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-2267
Practice Address - Country:US
Practice Address - Phone:304-598-2931
Practice Address - Fax:304-598-3020
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007724183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist