Provider Demographics
NPI:1073966883
Name:BATSON, JOHN ALLEN SR
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALLEN
Last Name:BATSON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1473
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631-1473
Mailing Address - Country:US
Mailing Address - Phone:970-328-1311
Mailing Address - Fax:970-328-1317
Practice Address - Street 1:13 MARKET STREET
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:CO
Practice Address - Zip Code:81631
Practice Address - Country:US
Practice Address - Phone:970-328-1311
Practice Address - Fax:970-328-1317
Is Sole Proprietor?:No
Enumeration Date:2016-07-16
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist