Provider Demographics
NPI:1740713999
Name:BASTAROS, SALLY MAGDY (PHARMD)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:MAGDY
Last Name:BASTAROS
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 1:1749 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5202
Mailing Address - Country:US
Mailing Address - Phone:646-672-1760
Mailing Address - Fax:646-672-1765
Practice Address - Street 1:1675 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3702
Practice Address - Country:US
Practice Address - Phone:212-348-7400
Practice Address - Fax:212-348-4286
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist