Provider Demographics
NPI:1801987920
Name:BASISTA, SANDRA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:BASISTA
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 1:3526 PAPE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-1734
Mailing Address - Country:US
Mailing Address - Phone:513-871-3125
Mailing Address - Fax:
Practice Address - Street 1:7717 BEECHMONT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-4203
Practice Address - Country:US
Practice Address - Phone:513-231-1943
Practice Address - Fax:513-231-1442
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03326752183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist