Provider Demographics
NPI:1861089526
Name:BATTAG;OA, MICHAEL TERRENCE (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TERRENCE
Last Name:BATTAG;OA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W CENTRAL ENTRANCE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-5448
Mailing Address - Country:US
Mailing Address - Phone:218-727-3010
Mailing Address - Fax:218-727-7586
Practice Address - Street 1:615 W CENTRAL ENTRANCE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-5448
Practice Address - Country:US
Practice Address - Phone:218-727-3010
Practice Address - Fax:218-727-7586
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist