Healthcare Provider Details

I. General information

NPI: 1639841141
Provider Name (Legal Business Name): SAMANTHA OZOFU WATSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2021
Last Update Date: 10/03/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E PIONEER PKWY
ARLINGTON TX
76010-5243
US

IV. Provider business mailing address

501 COUNTRY WOOD CT
ARLINGTON TX
76011-2227
US

V. Phone/Fax

Practice location:
  • Phone: 817-860-9510
  • Fax:
Mailing address:
  • Phone: 817-584-4618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number69519
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: