Healthcare Provider Details

I. General information

NPI: 1871649764
Provider Name (Legal Business Name): JEFFREY ALLAN BATES BS PHARM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 DENMARK ST
BALDWIN MI
49304-7500
US

IV. Provider business mailing address

9630 BLACKHAWK TRL
HOWARD CITY MI
49329-8742
US

V. Phone/Fax

Practice location:
  • Phone: 231-745-4648
  • Fax:
Mailing address:
  • Phone: 231-937-7578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number5302027791
License Number StateMI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: