Provider Demographics
NPI:1396701603
Name:BATTEN, LARRY L (RPH)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:L
Last Name:BATTEN
Suffix:
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 1:2001 PIONEER ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-6249
Mailing Address - Country:US
Mailing Address - Phone:912-283-1646
Mailing Address - Fax:
Practice Address - Street 1:2001 PIONEER ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-6249
Practice Address - Country:US
Practice Address - Phone:912-283-1646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00219051AMedicaid
GA00219051AMedicaid
GA1124318Medicare UPIN