Provider Demographics
NPI:1609062280
Name:BASS, KATHERINE JEAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JEAN
Last Name:BASS
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 1:5030 CHARTER OAK LN SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-1024
Mailing Address - Country:US
Mailing Address - Phone:319-892-0339
Mailing Address - Fax:
Practice Address - Street 1:811 5TH AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2421
Practice Address - Country:US
Practice Address - Phone:319-364-4181
Practice Address - Fax:319-363-5448
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist