Provider Demographics
NPI:1932499126
Name:BASS, AMY WOODS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:WOODS
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 1:7975 COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-7211
Mailing Address - Country:US
Mailing Address - Phone:662-380-1674
Mailing Address - Fax:
Practice Address - Street 1:2996 CHURCH RD E
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9825
Practice Address - Country:US
Practice Address - Phone:662-349-4418
Practice Address - Fax:662-349-6689
Is Sole Proprietor?:No
Enumeration Date:2011-04-09
Last Update Date:2011-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-010132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist