Healthcare Provider Details

I. General information

NPI: 1316777196
Provider Name (Legal Business Name): BROOKLYNN KARIN WATSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 22ND AVE
MONROE WI
53566-1569
US

IV. Provider business mailing address

W4047 COUNTY ROAD C
MONTICELLO WI
53570-9727
US

V. Phone/Fax

Practice location:
  • Phone: 608-324-2259
  • Fax: 608-324-1131
Mailing address:
  • Phone: 815-980-1675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number22722-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: