Provider Demographics
NPI:1629670229
Name:BAZEMORE, MARY PILSON (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:PILSON
Last Name:BAZEMORE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:PILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:15 SHEFTALL CV
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-2632
Mailing Address - Country:US
Mailing Address - Phone:276-340-3118
Mailing Address - Fax:
Practice Address - Street 1:14030 ABERCORN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1935
Practice Address - Country:US
Practice Address - Phone:912-344-9671
Practice Address - Fax:912-344-9665
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist