Healthcare Provider Details

I. General information

NPI: 1972493690
Provider Name (Legal Business Name): MADISON WATT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2025
Last Update Date: 07/04/2025
Certification Date: 07/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 HAVEMANN RD
CELINA OH
45822-9300
US

IV. Provider business mailing address

814 ABRAHAM CT
WAPAKONETA OH
45895-7413
US

V. Phone/Fax

Practice location:
  • Phone: 419-586-3777
  • Fax:
Mailing address:
  • Phone: 567-356-7562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03445543
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: