Healthcare Provider Details

I. General information

NPI: 1063717601
Provider Name (Legal Business Name): REBECCA HEAVNER WATSON R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 US HIGHWAY 70A E
HILDEBRAN NC
28637-8108
US

IV. Provider business mailing address

200 US HIGHWAY 70A E
HILDEBRAN NC
28637-8108
US

V. Phone/Fax

Practice location:
  • Phone: 828-397-7479
  • Fax: 828-397-2031
Mailing address:
  • Phone: 828-397-7479
  • Fax: 828-397-2031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11355
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: