Jason Basham
Individual provider Active NPI Pharmacist · Conway, SC
NPI 1194181669 · NPPES record last updated Jan 13, 2016
Key facts
- NPI
- 1194181669
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 9657 (SC)
- Practice address
- 2219 Main St
Conway, SC 29526-3340 - Phone
- (843) 488-4400
- Fax
- (843) 488-4405
- NPI assigned
- Jan 13, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9657 | SC | MD | Military Health Care Provider |
| 011627 | KY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rivertown Pharmacy Inc | Past | Accepting new patients | |
| Rivertown Pharmacy Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 9657 | SC | Yes |
| Pharmacist | 183500000X | 011627 | KY |
Addresses
Primary practice location
2219 Main St
Conway, SC 29526-3340
Mailing address
2219 Main St
Conway, SC 29526-3340
Phone (843) 488-4400
Other providers in Conway, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 13, 2016. 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.