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General NPI Number Information
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NPI Number | 1013114685
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Entity Type | Individual
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Provider Name | CHARLES EDDIE WATERS PHARMD, BCPS, CGP
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Gender | Male
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 11/28/2012
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Provider Practice Location Address
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Address Line | 1411 W BADDOUR PKWY
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City | LEBANON
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State | TN
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Zip | 37087-2513
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Country | US
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Telephone | 678-314-0983
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Fax |
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Provider Business Mailing Address
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Address Line | 1411 W BADDOUR PKWY
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City | LEBANON
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State | TN
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Zip | 37087-2513
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Country | US
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Telephone | 678-314-0983
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 0000036217
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | RPH023088
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License Number State | GA
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