Basic Information
| Provider Information | |||||||||
| NPI: | 1003009002 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BASIN | ||||||||
| FirstName: | MAYA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RPH. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 174TH ST | ||||||||
| Address2: | APT 704 | ||||||||
| City: | SUNNY ISLES BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331603323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9173590977 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 250 174TH ST | ||||||||
| Address2: | APT 704 | ||||||||
| City: | SUNNY ISLES BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331603323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9173590977 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2007 | ||||||||
| LastUpdateDate: | 01/25/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 047436 | NY | Y | Pharmacy Service Providers | Pharmacist | 183500000X | 28RI03417200 | NJ | N | Pharmacy Service Providers | Pharmacist | 183500000X | PS47269 | FL | N | Pharmacy Service Providers | Pharmacist |
ID Information
| ID | Type | State | Issuer | Description | 047436 | 01 | NY | PHARMACIST | OTHER | 28RI03417200 | 01 | NJ | PHARMACIST | OTHER | PS47269 | 01 | FL | PHARMACIST | OTHER |