Healthcare Provider Details

I. General information

NPI: 1912502154
Provider Name (Legal Business Name): STEPHANIE WATKINS KIRKLAND RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 INDUSTRIAL BLVD
HAWKINSVILLE GA
31036-2103
US

IV. Provider business mailing address

342 INDUSTRIAL BLVD
HAWKINSVILLE GA
31036-2103
US

V. Phone/Fax

Practice location:
  • Phone: 478-609-1717
  • Fax: 478-783-1404
Mailing address:
  • Phone: 478-609-1717
  • Fax: 478-783-1404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH018449
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: