Provider Demographics
NPI:1104367895
Name:BATTISTA, THEREA (RPH)
Entity Type:Individual
Prefix:
First Name:THEREA
Middle Name:
Last Name:BATTISTA
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 1:54 POPLAR DR
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-3231
Mailing Address - Country:US
Mailing Address - Phone:201-602-3840
Mailing Address - Fax:973-993-9999
Practice Address - Street 1:54 POPLAR DR
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-3231
Practice Address - Country:US
Practice Address - Phone:201-602-3840
Practice Address - Fax:973-993-9999
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01613000183500000X, 1835G0303X, 1835N1003X, 1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care