Provider Demographics
NPI:1184113953
Name:BASS, MELISSA C (PHARMD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:C
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 1:8782 NC HWY 90 E
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NC
Mailing Address - Zip Code:28678
Mailing Address - Country:US
Mailing Address - Phone:704-585-2102
Mailing Address - Fax:
Practice Address - Street 1:8782 NC HWY 90 E
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NC
Practice Address - Zip Code:28678
Practice Address - Country:US
Practice Address - Phone:704-585-2102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist