Provider Demographics
NPI:1104426444
Name:BATEMAN, LOUIS MARK (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:MARK
Last Name:BATEMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9210 E 46TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-7207
Mailing Address - Country:US
Mailing Address - Phone:918-381-7675
Mailing Address - Fax:
Practice Address - Street 1:207 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74112-2201
Practice Address - Country:US
Practice Address - Phone:918-838-2937
Practice Address - Fax:918-836-8517
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14487183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist