Healthcare Provider Details

I. General information

NPI: 1386297141
Provider Name (Legal Business Name): BASIN MIXTURES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6309 MILL LN
BROOKLYN NY
11234-5512
US

IV. Provider business mailing address

6309 MILL LN
BROOKLYN NY
11234-5512
US

V. Phone/Fax

Practice location:
  • Phone: 718-444-4749
  • Fax: 718-444-4376
Mailing address:
  • Phone: 718-444-4749
  • Fax: 718-444-4376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HASSAN MUYIR
Title or Position: OWNER
Credential:
Phone: 718-444-4749