Provider Demographics
NPI:1194871251
Name:GAM, PAMELA BASS (RPH)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:BASS
Last Name:GAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 SANDERS STREET
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830
Mailing Address - Country:US
Mailing Address - Phone:334-887-3989
Mailing Address - Fax:
Practice Address - Street 1:221 E SOUTH STREET
Practice Address - Street 2:
Practice Address - City:DADEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36853
Practice Address - Country:US
Practice Address - Phone:256-825-0063
Practice Address - Fax:256-825-5584
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10414183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist