Keandra Bates, PHARMD
Individual provider Active NPI Pharmacist · Northford, CT
NPI 1124716667 · NPPES record last updated Apr 24, 2023
Key facts
- NPI
- 1124716667
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PCT.0014606 (CT)
- Practice address
- 1395 Middletown Ave
Northford, CT 06472-1395 - Phone
- (203) 484-0431
- NPI assigned
- Apr 24, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PCT.0014606 | CT | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Maxi Drug Inc | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PCT.0014606 | CT | Yes |
Addresses
Primary practice location
1395 Middletown Ave
Northford, CT 06472-1395
Mailing address
31 James Drew LN
Bristol, CT 06010-7862
Other providers in Northford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.