Individual
MRS. STACY LOUISEB BATES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
6390 BROOKLYN BLVD, BROOKLYN CENTER, MN 55429-2600
(763) 585-9946
(763) 569-9904
Mailing address
6390 BROOKLYN BLVD, BROOKLYN CENTER, MN 55429-2600
(763) 585-9946
(763) 585-9418
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
119993
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2422323
—
MN
Enumeration date
10/21/2011
Last updated
10/21/2011
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