Healthcare Provider Details

I. General information

NPI: 1568372266
Provider Name (Legal Business Name): MADISON WATTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 5TH AVE
KOTZEBUE AK
99752
US

IV. Provider business mailing address

355 PONDEROSA AVE
ESTES PARK CO
80517-7021
US

V. Phone/Fax

Practice location:
  • Phone: 907-442-3321
  • Fax:
Mailing address:
  • Phone: 636-544-8066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0025667
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: