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General NPI Number Information
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NPI Number | 1013252576
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Entity Type | Individual
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Provider Name | CICELY R. WHITESIDES-WATKINS PHARMD
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Gender | Female
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Dates
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Enumeration Date | 12/10/2012
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 1313 WATERS EDGE DRIVE
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City | AUGUSTA
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State | GA
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Zip | 30901
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Country | US
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Telephone | 706-869-5197
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Fax | 706-739-1702
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Provider Business Mailing Address
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Address Line | P.O. BOX 84052
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City | LEXINGTON
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State | SC
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Zip | 29073
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Country | US
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Telephone | 803-429-7720
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Fax | 706-739-1702
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH021982
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS56162
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 18489
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 10646
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License Number State | SC
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