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General NPI Number Information
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NPI Number | 1053869503
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Entity Type | Individual
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Provider Name | RYAN P WATTS PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/13/2016
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Last Update Date | 09/18/2016
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Provider Practice Location Address
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Address Line | 3510 RICHLAND AVE W
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City | AIKEN
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State | SC
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Zip | 29801-6312
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Country | US
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Telephone | 513-238-2467
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Fax |
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Provider Business Mailing Address
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Address Line | 680 CRANE CREEK DR APRT 228
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City | AUGUSTA
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State | GA
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Zip | 30907-3075
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Country | US
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Telephone | 513-238-2467
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 36848
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License Number State | SC
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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 | 0202214402
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License Number State | VA
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