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MR. WILLARD L BASS RPH
>> Pharmacist >> Pharmacy Service ProvidersRegistrant NPI Number: 1477878379
Individual Registrant:MR. WILLARD L BASS RPH
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
111 TOWN AND COUNTRY DR PALATKA, FL 32177-3962 US
Tel: 386-325-7562 Fax: 386-326-0281
Tel: 386-325-7562 Fax: 386-326-0281
Contact information for business:
320 S FERN ST SAN MATEO, FL 32187-2438 US
Tel: 352-478-5577 Fax: 386-326-0281
Tel: 352-478-5577 Fax: 386-326-0281
Registration Information:
NPI: 1477878379
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 183500000X | Pharmacy Service Providers Pharmacist | FL | PS13424 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
