Provider Demographics
NPI:1588908487
Name:BATCHELDER, GREY ASHER (RPH)
Entity type:Individual
Prefix:
First Name:GREY
Middle Name:ASHER
Last Name:BATCHELDER
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 1:3504 VENETIAN VILLA CIR
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-5350
Mailing Address - Country:US
Mailing Address - Phone:386-795-3570
Mailing Address - Fax:
Practice Address - Street 1:3504 VENETIAN VILLA CIR
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-5350
Practice Address - Country:US
Practice Address - Phone:386-795-3570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0034255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS0034255OtherSTATE LICENSE