Provider Demographics
NPI:1891127551
Name:SARANTIS, BASIL JOHN (PHARM D)
Entity Type:Individual
Prefix:
First Name:BASIL
Middle Name:JOHN
Last Name:SARANTIS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3542 BROOKSTONE DR APT D
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1171
Mailing Address - Country:US
Mailing Address - Phone:585-314-3929
Mailing Address - Fax:
Practice Address - Street 1:4825 MARBURG AVE UNIT A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-5013
Practice Address - Country:US
Practice Address - Phone:513-631-5690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03233093OtherPHARMACIST LICENSE NUMBER