Provider Demographics
NPI:1073938601
Name:BATES, LUCINDA W (RPH)
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:W
Last Name:BATES
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 1:1167 POWDER SPRINGS ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3958
Mailing Address - Country:US
Mailing Address - Phone:770-799-1684
Mailing Address - Fax:770-799-1685
Practice Address - Street 1:1167 POWDER SPRINGS ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3958
Practice Address - Country:US
Practice Address - Phone:770-799-1684
Practice Address - Fax:770-799-1685
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH012768183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist