Healthcare Provider Details

I. General information

NPI: 1437146347
Provider Name (Legal Business Name): JAMES ROBERT WATTS II R. PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAY ROBERT WATTS R. PH.

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 NEWBERRY ST NW
AIKEN SC
29801-3929
US

IV. Provider business mailing address

333 NEWBERRY ST NW
AIKEN SC
29801-3929
US

V. Phone/Fax

Practice location:
  • Phone: 803-649-1776
  • Fax: 803-641-0205
Mailing address:
  • Phone: 803-599-1776
  • Fax: 803-649-7381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6388
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: