=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053483834
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WATT BROS PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 830 N GRAND AVE E
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62702-3933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-522-3331
-----------------------------------------------------
Fax | 217-522-9029
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 830 N GRAND AVE E
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62702-3933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRE
-----------------------------------------------------
Name | JOHN WATT
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 217-522-3331
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------