Provider Demographics
NPI:1407450455
Name:BASORE, STEVE (RPH)
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:BASORE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 W STEPHENS CT
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-3008
Mailing Address - Country:US
Mailing Address - Phone:903-681-4440
Mailing Address - Fax:
Practice Address - Street 1:807 E TYLER ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-2139
Practice Address - Country:US
Practice Address - Phone:903-675-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist