Healthcare Provider Details

I. General information

NPI: 1407867062
Provider Name (Legal Business Name): WATERS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAIN ST
RIPLEY OH
45167-1232
US

IV. Provider business mailing address

100 MAIN ST
RIPLEY OH
45167-1232
US

V. Phone/Fax

Practice location:
  • Phone: 937-392-4020
  • Fax: 937-392-4078
Mailing address:
  • Phone: 937-392-4020
  • Fax: 937-392-4078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number020976000
License Number StateOH

VIII. Authorized Official

Name: ROBERT WATERS
Title or Position: PRESIDENT
Credential:
Phone: 937-392-4020