Healthcare Provider Details

I. General information

NPI: 1043963986
Provider Name (Legal Business Name): CYNTHIA BATIE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2B STATE ROAD 344
EDGEWOOD NM
87015-6951
US

IV. Provider business mailing address

12 CAJUN LN
EDGEWOOD NM
87015-9134
US

V. Phone/Fax

Practice location:
  • Phone: 505-286-9040
  • Fax:
Mailing address:
  • Phone: 505-259-0516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number00005585
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: