Healthcare Provider Details

I. General information

NPI: 1730761776
Provider Name (Legal Business Name): HEATHER WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18022 68TH AVE NE
KENMORE WA
98028-2400
US

IV. Provider business mailing address

18022 68TH AVE NE
KENMORE WA
98028-2400
US

V. Phone/Fax

Practice location:
  • Phone: 425-424-2320
  • Fax:
Mailing address:
  • Phone: 425-424-2320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA60809261
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: