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Individual

SHANNON BATES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHARMD

Contact information

Practice address
702 W MAIN ST, TUPELO, MS 38804-3734
(662) 840-4818
Mailing address
148 COUNTY ROAD 226, CORINTH, MS 38834-7668
(662) 415-5378

Taxonomy

Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
Primary
E-16137
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
E-16137
MISSISSIPPI BOARD OF PHARMACY
MS
Enumeration date
09/28/2022
Last updated
09/28/2022
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