Provider Demographics
NPI:1447529151
Name:BATES, KAREN P (PHARMD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:P
Last Name:BATES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2627
Mailing Address - Country:US
Mailing Address - Phone:601-969-5388
Mailing Address - Fax:601-969-5381
Practice Address - Street 1:955 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2627
Practice Address - Country:US
Practice Address - Phone:601-969-5388
Practice Address - Fax:601-969-5381
Is Sole Proprietor?:No
Enumeration Date:2011-12-26
Last Update Date:2011-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-09974183500000X
TX39489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist