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General NPI Number Information
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NPI Number | 1629670229
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Entity Type | Individual
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Provider Name | MARY PILSON BAZEMORE PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/10/2020
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Last Update Date | 11/10/2020
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Provider Practice Location Address
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Address Line | 14030 ABERCORN ST
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City | SAVANNAH
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State | GA
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Zip | 31419-1935
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Country | US
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Telephone | 912-344-9671
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Fax | 912-344-9665
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Provider Business Mailing Address
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Address Line | 15 SHEFTALL CV
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City | SAVANNAH
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State | GA
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Zip | 31410-2632
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Country | US
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Telephone | 276-340-3118
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 028823
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License Number State | GA
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