Individual
FAWN BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5637 CLEVELAND AVE, STEVENSVILLE, MI 49127-9613
(269) 429-8441
(269) 429-7578
Mailing address
8745 HOLLYWOOD RD, BERRIEN SPRINGS, MI 49103-9104
(269) 449-2110
(269) 429-7578
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5315122181
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
227434
NABP PERSONAL
—
Enumeration date
12/31/2020
Last updated
12/31/2020
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