Provider Demographics
NPI:1336829613
Name:BASS, JARROD LANE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JARROD
Middle Name:LANE
Last Name:BASS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 LEGACY CT APT 17
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-5124
Mailing Address - Country:US
Mailing Address - Phone:252-619-8633
Mailing Address - Fax:
Practice Address - Street 1:502 W THURMAN RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-7020
Practice Address - Country:US
Practice Address - Phone:252-631-5444
Practice Address - Fax:252-631-5110
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist