Provider Demographics
NPI:1356508485
Name:BATES, JULIE FELICIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:FELICIA
Last Name:BATES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4329 REDWOOD AVE #2
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL RAY
Mailing Address - State:CA
Mailing Address - Zip Code:90292
Mailing Address - Country:US
Mailing Address - Phone:310-823-6997
Mailing Address - Fax:
Practice Address - Street 1:8540 SO SEPULVEDA
Practice Address - Street 2:PLAZA WEST PHARMACY
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045
Practice Address - Country:US
Practice Address - Phone:310-645-6422
Practice Address - Fax:310-645-9750
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist