Provider Demographics
NPI:1154643492
Name:BATES, CHARLES L (BS PHARM)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:L
Last Name:BATES
Suffix:
Gender:M
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 HORATIO ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-1461
Mailing Address - Country:US
Mailing Address - Phone:315-738-0759
Mailing Address - Fax:315-738-0759
Practice Address - Street 1:710 HORATIO ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-1461
Practice Address - Country:US
Practice Address - Phone:315-738-0759
Practice Address - Fax:315-738-0759
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032350183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist