MEDICARE: DR. VICTORIA ANNE GATES 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	1835G0303X	Geriatric Pharmacist	5302036858	MI

General Provider Information

NPI Number	:	1790017135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTORIA ANNE GATES PHARMD

Provider Business Mailing Address
First Line	:	2433 BEACON HILL CT
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-1513
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2433 BEACON HILL CT
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-1513
Country	:	US
Telephone Number	:	248-701-0208
Fax Number	:

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

Provider Enumeration Date	:	02/10/2010
Last Update Date	:	02/10/2010

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