MEDICARE: DR. ACHIROOKAN G WATSON PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PR71747	ME

General Provider Information

NPI Number	:	1295516078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ACHIROOKAN G WATSON PHARMD

Provider Business Mailing Address
First Line	:	91 AUBURN ST
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04103-6008
Country	:	US
Telephone Number	:	207-232-4900
Fax Number	:

Provider Business Practice Location Address
First Line	:	91 AUBURN ST
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04103-6008
Country	:	US
Telephone Number	:	207-232-4900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2023
Last Update Date	:	10/09/2023

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