Healthcare Provider Details

I. General information

NPI: 1689769200
Provider Name (Legal Business Name): KIMBERLY WATSON PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 WEST 7TH STREET DEPT 119/LR
LITTLE ROCK AR
72205
US

IV. Provider business mailing address

4300 WEST 7TH STREET DEPT 119/LR
LITTLE ROCK AR
72205
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-1000
  • Fax:
Mailing address:
  • Phone: 501-257-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPD09745
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: