Healthcare Provider Details

I. General information

NPI: 1174846190
Provider Name (Legal Business Name): GELSOMINA BASILONE FRANK RPH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 ROUTE 55 BOX 335
POUGHQUAG NY
12570-5115
US

IV. Provider business mailing address

PO BOX 335 2540 ROUTE 55
POUGHQUAG NY
12570-0335
US

V. Phone/Fax

Practice location:
  • Phone: 845-724-3200
  • Fax: 845-724-3767
Mailing address:
  • Phone: 845-724-3200
  • Fax: 845-724-3767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number042162-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: