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NPI Code Detail

MEDICARE: MR. ELROY DWAYNE WATSON

MEDICARE: MR. ELROY DWAYNE WATSON
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
1183500000XPharmacist35589TX

General Provider Information

NPI Number : 1407142318
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ELROY DWAYNE WATSON
Provider Business Mailing Address
First Line : PO BOX 762590
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78245-7590
Country : US
Telephone Number : 210-326-5772
Fax Number :
Provider Business Practice Location Address
First Line : 3227 SE MILITARY DR
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78223-3876
Country : US
Telephone Number : 210-326-5772
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2011
Last Update Date : 06/20/2011

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