Provider Demographics
NPI:1700188406
Name:BATES, DAVID ALAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALAN
Last Name:BATES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 125
Mailing Address - Street 2:NAHATA'DZIIL HEALTH CENTER CHIIH'TOH BLVD.
Mailing Address - City:SANDERS
Mailing Address - State:AZ
Mailing Address - Zip Code:86512
Mailing Address - Country:US
Mailing Address - Phone:928-688-5696
Mailing Address - Fax:
Practice Address - Street 1:NAHATA'DZIIL HEALTH CENTER CHIIH'TOH BLVD.
Practice Address - Street 2:
Practice Address - City:SANDERS
Practice Address - State:AZ
Practice Address - Zip Code:86512
Practice Address - Country:US
Practice Address - Phone:928-688-5696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0435861835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist