Healthcare Provider Details

I. General information

NPI: 1487936662
Provider Name (Legal Business Name): MARCY MICHELLE WATSON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 FRANKFORT AVE
LOUISVILLE KY
40207-2557
US

IV. Provider business mailing address

3700 FRANKFORT AVE
LOUISVILLE KY
40207-2557
US

V. Phone/Fax

Practice location:
  • Phone: 502-899-9353
  • Fax: 502-899-9441
Mailing address:
  • Phone: 502-899-9353
  • Fax: 502-899-9441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number011826
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: