Provider Demographics
NPI:1609583533
Name:BATES, KYLE JAMES (PHARMD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:JAMES
Last Name:BATES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 W TWIN OAKS PL
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-1298
Mailing Address - Country:US
Mailing Address - Phone:405-229-2240
Mailing Address - Fax:
Practice Address - Street 1:1000 W BOISE CIR
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-4900
Practice Address - Country:US
Practice Address - Phone:918-994-8149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18476183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist