Healthcare Provider Details

I. General information

NPI: 1043305048
Provider Name (Legal Business Name): SHAWNEE LYNN BATES R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 W. 10TH STREET
INDIANAPOLIS IN
46202
US

IV. Provider business mailing address

7812 PARKDALE DR
ZIONSVILLE IN
46077-8012
US

V. Phone/Fax

Practice location:
  • Phone: 317-554-0000
  • Fax:
Mailing address:
  • Phone: 317-769-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26017898A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: