MEDICARE: GARY BENTLEY BASS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	06935	AR

General Provider Information

NPI Number	:	1558554303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY BENTLEY BASS

Provider Business Mailing Address
First Line	:	1801 BROADWAY ST
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72206-1222
Country	:	US
Telephone Number	:	501-374-6565
Fax Number	:	501-374-6231

Provider Business Practice Location Address
First Line	:	1801 BROADWAY ST
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72206-1222
Country	:	US
Telephone Number	:	501-374-6565
Fax Number	:	501-374-6231

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2007
Last Update Date	:	08/24/2007

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Directions to “ GARY BENTLEY BASS ” Practice Location

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