Provider Demographics
NPI:1487690970
Name:BASS & LAWRENCE CORPORATION
Entity type:Organization
Organization Name:BASS & LAWRENCE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER,PIC,AO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:757-533-6566
Mailing Address - Street 1:261 GRANBY ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1813
Mailing Address - Country:US
Mailing Address - Phone:757-533-6566
Mailing Address - Fax:757-533-6569
Practice Address - Street 1:261 GRANBY ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1813
Practice Address - Country:US
Practice Address - Phone:757-533-6566
Practice Address - Fax:757-533-6569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 332B00000X
VA02010037113336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008512761Medicaid
2105054OtherPK
2105054OtherPK
4835837OtherOTHER ID NUMBER-COMMERCIAL NUMBER
VA008512761Medicaid