Provider Demographics
NPI:1841513926
Name:BASU, TANYA (PHARMD, JD)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:BASU
Suffix:
Gender:F
Credentials:PHARMD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 VALLEY HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1951
Mailing Address - Country:US
Mailing Address - Phone:732-586-5298
Mailing Address - Fax:
Practice Address - Street 1:1 MILLBROOK PLZ
Practice Address - Street 2:
Practice Address - City:MILL HALL
Practice Address - State:PA
Practice Address - Zip Code:17751-1911
Practice Address - Country:US
Practice Address - Phone:570-748-6775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP440491183500000X
NJ28RI02941100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist