Provider Demographics
NPI:1124312210
Name:BATES, KATHRYN L (RPH)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:BATES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:L
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:652 KIRK RD
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-4723
Mailing Address - Country:US
Mailing Address - Phone:630-587-0855
Mailing Address - Fax:
Practice Address - Street 1:652 KIRK RD
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-4723
Practice Address - Country:US
Practice Address - Phone:630-893-2770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47225183500000X
IL051041068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist