Provider Demographics
NPI:1518514124
Name:BATES, ELIZABETH GAYLIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:GAYLIN
Last Name:BATES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:GAYLIN
Other - Last Name:NASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:518 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-6024
Mailing Address - Country:US
Mailing Address - Phone:870-403-9400
Mailing Address - Fax:870-245-1790
Practice Address - Street 1:710 N WEST AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4655
Practice Address - Country:US
Practice Address - Phone:870-863-8111
Practice Address - Fax:870-245-1790
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD13687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist