Healthcare Provider Details

I. General information

NPI: 1982919858
Provider Name (Legal Business Name): WILLIAM DAVID WATKINS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 08/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9045 W INDIAN SCHOOL RD
PHOENIX AZ
85037-2029
US

IV. Provider business mailing address

12510 S 175TH AVE
GOODYEAR AZ
85338-5762
US

V. Phone/Fax

Practice location:
  • Phone: 623-877-3186
  • Fax: 623-877-3193
Mailing address:
  • Phone: 623-293-0372
  • Fax: 623-877-3193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12293
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: