Individual
MR. BRENT JUDE BASHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
675 TROY SCHENECTADY RD, TARGET PHARMACY T1915, LATHAM, NY 12110-2493
(518) 782-1360
Mailing address
40 LINDA LN, SCHENECTADY, NY 12309-1962
(518) 452-0148
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
040628
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01309571
—
NY
Enumeration date
11/27/2007
Last updated
05/11/2010
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