Provider Demographics
NPI:1033835830
Name:BATISTA, ALEXANDRIA MARIA (RPH)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:MARIA
Last Name:BATISTA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N HARRISON ST UNIT 5
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:IN
Mailing Address - Zip Code:46567-1071
Mailing Address - Country:US
Mailing Address - Phone:574-325-0048
Mailing Address - Fax:
Practice Address - Street 1:308 S HUNTINGTON ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:IN
Practice Address - Zip Code:46567-1572
Practice Address - Country:US
Practice Address - Phone:574-457-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCV2201275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist