Healthcare Provider Details

I. General information

NPI: 1013342385
Provider Name (Legal Business Name): AMY ELIZABETH BATES PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 ALLEN STREET
TOMBSTONE AZ
85638
US

IV. Provider business mailing address

PO BOX 1279
TOMBSTONE AZ
85638-1279
US

V. Phone/Fax

Practice location:
  • Phone: 520-457-3543
  • Fax:
Mailing address:
  • Phone: 520-457-3543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS014859
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: