Provider Demographics
NPI:1720698863
Name:BASS, ALLISON R (PHARMD, BCOP)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:R
Last Name:BASS
Suffix:
Gender:F
Credentials:PHARMD, BCOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3757 CASA DEL SOL LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-1817
Mailing Address - Country:US
Mailing Address - Phone:214-551-0302
Mailing Address - Fax:
Practice Address - Street 1:3500 GASTON AVENUE
Practice Address - Street 2:PHARMACY DEPT/HOBLITZELLE BASEMENT
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246
Practice Address - Country:US
Practice Address - Phone:214-551-0302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX491371835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology