Healthcare Provider Details

I. General information

NPI: 1487690970
Provider Name (Legal Business Name): BASS & LAWRENCE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 GRANBY ST
NORFOLK VA
23510-1813
US

IV. Provider business mailing address

261 GRANBY ST
NORFOLK VA
23510-1813
US

V. Phone/Fax

Practice location:
  • Phone: 757-533-6566
  • Fax: 757-533-6569
Mailing address:
  • Phone: 757-533-6566
  • Fax: 757-533-6569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201003711
License Number StateVA

VIII. Authorized Official

Name: DAVID BASS
Title or Position: OWNER,PIC,AO
Credential: RPH
Phone: 757-533-6566