Provider Demographics
NPI:1174299382
Name:BASHORE, ELIZABETH PERKINS
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:PERKINS
Last Name:BASHORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 PLEASANT VIEW DR APT 36
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-5003
Mailing Address - Country:US
Mailing Address - Phone:931-801-5870
Mailing Address - Fax:
Practice Address - Street 1:31 MIDWAY ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3246
Practice Address - Country:US
Practice Address - Phone:276-642-0032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202219859183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist