Provider Demographics
NPI:1720233422
Name:GATES, CHARLES MICHAEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MICHAEL
Last Name:GATES
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 1:3009 NW WILSON ST.
Mailing Address - Street 2:ATTN: CREDENTIALS
Mailing Address - City:FORT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503-9042
Mailing Address - Country:US
Mailing Address - Phone:580-458-2134
Mailing Address - Fax:580-458-2314
Practice Address - Street 1:3009 NW WILSON ST.
Practice Address - Street 2:ATTN: CREDENTIALS
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-9042
Practice Address - Country:US
Practice Address - Phone:580-458-2134
Practice Address - Fax:580-458-2314
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK135441835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist