Individual
JASON BASHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2219 MAIN ST, CONWAY, SC 29526-3340
(843) 488-4400
(843) 488-4405
Mailing address
2219 MAIN ST, CONWAY, SC 29526-3340
(843) 488-4400
(843) 488-4405
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
011627
KY
183500000X
Pharmacist
Primary
9657
SC
Other
Enumeration date
01/13/2016
Last updated
01/13/2016
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