Provider Demographics
NPI:1881941185
Name:BASKO, PHILIP JAMES (PHARMD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:JAMES
Last Name:BASKO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 HILLVIEW PL
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-6205
Mailing Address - Country:US
Mailing Address - Phone:814-828-7658
Mailing Address - Fax:
Practice Address - Street 1:190 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-1633
Practice Address - Country:US
Practice Address - Phone:716-652-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist