Provider Demographics
NPI:1851438576
Name:CHRISTOPHER A. BASSOLINO PHARMACY CORP.
Entity Type:Organization
Organization Name:CHRISTOPHER A. BASSOLINO PHARMACY CORP.
Other - Org Name:90TH ST. PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:BASSOLINO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:212-289-9168
Mailing Address - Street 1:1260 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-0516
Mailing Address - Country:US
Mailing Address - Phone:212-289-9168
Mailing Address - Fax:212-427-3320
Practice Address - Street 1:1260 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-0516
Practice Address - Country:US
Practice Address - Phone:212-289-9168
Practice Address - Fax:212-427-3320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0205503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy