Provider Demographics
NPI:1578613584
Name:BASS, RANDY JOE (RPH)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:JOE
Last Name:BASS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 W BURROWS LN
Mailing Address - Street 2:
Mailing Address - City:BATTLEFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65619-9552
Mailing Address - Country:US
Mailing Address - Phone:417-725-5134
Mailing Address - Fax:
Practice Address - Street 1:TAYLOR HEALTH AND WELLNESS CTR
Practice Address - Street 2:901 S. NATIONAL
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65897-0001
Practice Address - Country:US
Practice Address - Phone:417-836-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO029494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist