Provider Demographics
NPI:1558632034
Name:WILLIAMS-BATES, MARVA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARVA
Middle Name:
Last Name:WILLIAMS-BATES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MARVA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:3531 THOMASVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-3405
Mailing Address - Country:US
Mailing Address - Phone:850-907-0112
Mailing Address - Fax:850-907-0117
Practice Address - Street 1:3531 THOMASVILLE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-3405
Practice Address - Country:US
Practice Address - Phone:850-907-0112
Practice Address - Fax:850-907-0117
Is Sole Proprietor?:No
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS25389183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist