MEDICARE: KYLE JAMES BATES PHARM.D.

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	18476	OK

General Provider Information

NPI Number	:	1609583533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE JAMES BATES PHARM.D.

Provider Business Mailing Address
First Line	:	3606 W TWIN OAKS PL
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74011-1298
Country	:	US
Telephone Number	:	405-229-2240
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 W BOISE CIR
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-4900
Country	:	US
Telephone Number	:	918-994-8149
Fax Number	:

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

Provider Enumeration Date	:	10/31/2022
Last Update Date	:	10/31/2022

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