Provider Demographics
NPI:1740609163
Name:BATES, VANESSA MICHELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:MICHELLE
Last Name:BATES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13619 INWOOD RD STE 380
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-4642
Mailing Address - Country:US
Mailing Address - Phone:844-800-5377
Mailing Address - Fax:214-782-9155
Practice Address - Street 1:13619 INWOOD RD STE 380
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-4642
Practice Address - Country:US
Practice Address - Phone:844-800-5377
Practice Address - Fax:214-782-9155
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000035535183500000X
LAPST.018237183500000X
MST-12361183500000X
ARPD11460183500000X
TX43551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist