Healthcare Provider Details

I. General information

NPI: 1609062280
Provider Name (Legal Business Name): KATHERINE JEAN BASS PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 5TH AVE SE
CEDAR RAPIDS IA
52403-2421
US

IV. Provider business mailing address

5030 CHARTER OAK LN SE
CEDAR RAPIDS IA
52403-1024
US

V. Phone/Fax

Practice location:
  • Phone: 319-364-4181
  • Fax: 319-363-5448
Mailing address:
  • Phone: 319-892-0339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20492
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: