Provider Demographics
NPI:1790388619
Name:BATES, CASEY J (RPH)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:J
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 1:20 HOLLY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-1303
Mailing Address - Country:US
Mailing Address - Phone:609-709-8444
Mailing Address - Fax:
Practice Address - Street 1:1 S NEW YORK RD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9610
Practice Address - Country:US
Practice Address - Phone:609-748-0717
Practice Address - Fax:609-748-1490
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04112900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist