Provider Demographics
NPI:1790851954
Name:AMIN, BASSAM A (PHARAMCIST)
Entity Type:Individual
Prefix:MR
First Name:BASSAM
Middle Name:A
Last Name:AMIN
Suffix:
Gender:M
Credentials:PHARAMCIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 COURT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6421
Mailing Address - Country:US
Mailing Address - Phone:718-923-1122
Mailing Address - Fax:718-923-9811
Practice Address - Street 1:205 COURT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6421
Practice Address - Country:US
Practice Address - Phone:718-923-1122
Practice Address - Fax:718-923-9811
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028056183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist