MEDICARE: COLTON BASS PHARMD

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	6414	SD

General Provider Information

NPI Number	:	1790136737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLTON BASS PHARMD

Provider Business Mailing Address
First Line	:	5708 E RED OAK DR APT 7
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57110-4015
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 S MINNESOTA AVE STE 1
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-4746
Country	:	US
Telephone Number	:	605-367-2000
Fax Number	:

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

Provider Enumeration Date	:	06/30/2016
Last Update Date	:	06/30/2016

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