Healthcare Provider Details

I. General information

NPI: 1669587721
Provider Name (Legal Business Name): BRIAN WATSON PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN-STANTON RD SUITE L022
NEWARK DE
19718-0001
US

IV. Provider business mailing address

2205 BYRNES CT APT. G
BEL AIR MD
21015-6738
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-6364
  • Fax:
Mailing address:
  • Phone: 443-350-4535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12805
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0003542
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17947
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: