Provider Demographics
NPI:1285964296
Name:BASANILOV, OLGA (PHARMD)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:BASANILOV
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:OLGA
Other - Middle Name:
Other - Last Name:BENYAMINOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:8 JOYCE RD
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-4320
Mailing Address - Country:US
Mailing Address - Phone:914-740-9767
Mailing Address - Fax:914-740-9769
Practice Address - Street 1:8 JOYCE RD
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4320
Practice Address - Country:US
Practice Address - Phone:914-740-9767
Practice Address - Fax:914-740-9769
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist