Provider Demographics
NPI:1013342385
Name:BATES, AMY ELIZABETH (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:BATES
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1279
Mailing Address - Street 2:
Mailing Address - City:TOMBSTONE
Mailing Address - State:AZ
Mailing Address - Zip Code:85638-1279
Mailing Address - Country:US
Mailing Address - Phone:520-457-3543
Mailing Address - Fax:
Practice Address - Street 1:524 ALLEN STREET
Practice Address - Street 2:
Practice Address - City:TOMBSTONE
Practice Address - State:AZ
Practice Address - Zip Code:85638
Practice Address - Country:US
Practice Address - Phone:520-457-3543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS014859183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS014859OtherPHARMACIST LICENSE