Provider Demographics
NPI:1982885497
Name:BASHANT, RODNEY G (PHARMACIST)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:G
Last Name:BASHANT
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PLEASANT AVE
Mailing Address - Street 2:RITE AID PHARMACY
Mailing Address - City:TUPPER LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12986
Mailing Address - Country:US
Mailing Address - Phone:518-359-3378
Mailing Address - Fax:
Practice Address - Street 1:4 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:TUPPER LAKE
Practice Address - State:NY
Practice Address - Zip Code:12986-1419
Practice Address - Country:US
Practice Address - Phone:518-359-3378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031175183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00666711Medicaid