Richard Truitt Bass, RPH
Individual provider Active NPI Pharmacist · Moultrie, GA
NPI 1053452045 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1053452045
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 12522 (GA)
- Practice address
- 101 N Main St
Moultrie, GA 31768-3863 - Phone
- (229) 985-9080
- Fax
- (229) 985-5600
- NPI assigned
- Feb 10, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12522 | GA | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chancy Drugs Moultrie LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 12522 | GA | Yes |
Addresses
Primary practice location
101 N Main St
Moultrie, GA 31768-3863
Mailing address
107 Lakewood Dr
Moultrie, GA 31788-8706
Phone (229) 985-6389
Other providers in Moultrie, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.