MEDICARE: VANESSA MICHELLE BATES PHARMD

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	0000035535	TN
2	183500000X	Pharmacist	PST.018237	LA
3	183500000X	Pharmacist	T-12361	MS
4	183500000X	Pharmacist	PD11460	AR
5	183500000X	Pharmacist	43551	TX

General Provider Information

NPI Number	:	1740609163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA MICHELLE BATES PHARMD

Provider Business Mailing Address
First Line	:	13619 INWOOD RD STE 380
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-4642
Country	:	US
Telephone Number	:	844-800-5377
Fax Number	:	214-782-9155

Provider Business Practice Location Address
First Line	:	13619 INWOOD RD STE 380
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-4642
Country	:	US
Telephone Number	:	844-800-5377
Fax Number	:	214-782-9155

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

Provider Enumeration Date	:	04/14/2014
Last Update Date	:	09/27/2023

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