Provider Demographics
NPI:1770834640
Name:BASS, JENNIFER H (RPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:H
Last Name:BASS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 MICHELLE CIR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1017
Mailing Address - Country:US
Mailing Address - Phone:678-577-0096
Mailing Address - Fax:
Practice Address - Street 1:100 PERIMETER CENTER PL NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30346-1204
Practice Address - Country:US
Practice Address - Phone:679-259-0762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021233183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist