Provider Demographics
NPI:1265909527
Name:MCBATH, JEFFREY L (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:L
Last Name:MCBATH
Suffix:
Gender:M
Credentials:PHARMACIST
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 3133
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91508-3133
Mailing Address - Country:US
Mailing Address - Phone:818-425-1485
Mailing Address - Fax:
Practice Address - Street 1:9449 SAN FERNANDO RD
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-1421
Practice Address - Country:US
Practice Address - Phone:818-252-2264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52423183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist