MEDICARE: DR. LAURA ASHLEY BATEH PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS49381	FL

General Provider Information

NPI Number	:	1548510613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA ASHLEY BATEH PHARM.D.

Provider Business Mailing Address
First Line	:	11546 SEDGEMOORE DRIVE SOUTH
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-1369
Country	:	US
Telephone Number	:	904-262-1490
Fax Number	:

Provider Business Practice Location Address
First Line	:	490 MARSH LANDING PARKWAY
Second Line	:	T-0967
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-5855
Country	:	US
Telephone Number	:	904-273-6387
Fax Number	:	904-273-6387

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2012
Last Update Date	:	09/14/2012

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