Provider Demographics
NPI:1295018448
Name:BASHAM, ANGELA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:BASHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 OAK FOREST LN
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-9795
Mailing Address - Country:US
Mailing Address - Phone:843-839-6606
Mailing Address - Fax:843-836-6632
Practice Address - Street 1:1021 OAK FOREST LN
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-9795
Practice Address - Country:US
Practice Address - Phone:843-839-6606
Practice Address - Fax:843-839-6632
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist