Provider Demographics
NPI:1780312082
Name:BASILE, ANTHONY VINCENT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:VINCENT
Last Name:BASILE
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 1:408 HILLSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-2906
Mailing Address - Country:US
Mailing Address - Phone:315-882-4184
Mailing Address - Fax:
Practice Address - Street 1:6789 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1640
Practice Address - Country:US
Practice Address - Phone:315-446-4660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-13
Last Update Date:2022-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069265183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist