Provider Demographics
NPI:1902408248
Name:BASS, SHERRY MELINDA (RPH)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:MELINDA
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 1:105 CENTENNIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:LINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:75771-8800
Mailing Address - Country:US
Mailing Address - Phone:903-882-5840
Mailing Address - Fax:903-882-0172
Practice Address - Street 1:105 CENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-8800
Practice Address - Country:US
Practice Address - Phone:903-882-5840
Practice Address - Fax:903-882-0172
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist