Provider Demographics
NPI:1568743672
Name:BASHAM, CHERYL ANNE
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANNE
Last Name:BASHAM
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 1:400 TULIP GROVE RD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1750
Mailing Address - Country:US
Mailing Address - Phone:615-391-0151
Mailing Address - Fax:615-889-6426
Practice Address - Street 1:400 TULIP GROVE RD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1750
Practice Address - Country:US
Practice Address - Phone:615-391-0151
Practice Address - Fax:615-889-6426
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC6835183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist