MEDICARE: LOGAN BATES RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03440676	OH

General Provider Information

NPI Number	:	1053980979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOGAN BATES RPH

Provider Business Mailing Address
First Line	:	501 E EMMITT AVE
Second Line	:
City	:	WAVERLY
State	:	OH
Zip	:	45690-1206
Country	:	US
Telephone Number	:	740-941-3017
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 E EMMITT AVE
Second Line	:
City	:	WAVERLY
State	:	OH
Zip	:	45690-1206
Country	:	US
Telephone Number	:	740-941-3017
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2021
Last Update Date	:	06/24/2021

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Directions to “ LOGAN BATES RPH” Practice Location

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