Healthcare Provider Details

I. General information

NPI: 1710575352
Provider Name (Legal Business Name): DEBORAH ANN WATKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26075 RIDGE RD
DAMASCUS MD
20872-1831
US

IV. Provider business mailing address

26075 RIDGE RD
DAMASCUS MD
20872-1831
US

V. Phone/Fax

Practice location:
  • Phone: 301-253-9418
  • Fax: 301-482-1179
Mailing address:
  • Phone: 301-253-9418
  • Fax: 301-482-1179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberT06873
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: