Provider Demographics
NPI:1790003705
Name:BATTAILE, THOMAS JR (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:BATTAILE
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3694 HIGHLAND AVE
Mailing Address - Street 2:SUITE 27
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-2613
Mailing Address - Country:US
Mailing Address - Phone:909-425-0311
Mailing Address - Fax:909-862-1199
Practice Address - Street 1:3694 HIGHLAND AVE
Practice Address - Street 2:SUITE 27
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-2613
Practice Address - Country:US
Practice Address - Phone:909-425-0311
Practice Address - Fax:909-862-1199
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH37161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist