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General NPI Number Information
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NPI Number | 1518522978
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Entity Type | Individual
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Provider Name | JORDAN BATES PHARMD
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Gender | Male
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Dates
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Enumeration Date | 05/01/2019
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Last Update Date | 10/15/2021
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Provider Practice Location Address
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Address Line | 2002 HOLCOMBE BLVD
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City | HOUSTON
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State | TX
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Zip | 77030-4211
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Country | US
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Telephone | 504-952-8470
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Fax |
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Provider Business Mailing Address
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Address Line | 2302 MILAM ST APT 1226
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City | HOUSTON
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State | TX
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Zip | 77006-2376
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | 64896
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License Number State | TX
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