Provider Demographics
NPI:1548510613
Name:BATEH, LAURA ASHLEY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ASHLEY
Last Name:BATEH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11546 SEDGEMOORE DRIVE SOUTH
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1369
Mailing Address - Country:US
Mailing Address - Phone:904-262-1490
Mailing Address - Fax:
Practice Address - Street 1:490 MARSH LANDING PARKWAY
Practice Address - Street 2:T-0967
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-5855
Practice Address - Country:US
Practice Address - Phone:904-273-6387
Practice Address - Fax:904-273-6387
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49381183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist