Provider Demographics
NPI:1659607182
Name:BASS, JESSICA ERIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ERIN
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 1:601 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-3501
Mailing Address - Country:US
Mailing Address - Phone:910-592-4058
Mailing Address - Fax:910-592-5780
Practice Address - Street 1:601 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-3501
Practice Address - Country:US
Practice Address - Phone:910-592-4058
Practice Address - Fax:910-592-5780
Is Sole Proprietor?:No
Enumeration Date:2009-10-17
Last Update Date:2009-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist