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General NPI Number Information
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NPI Number | 1073150819
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Entity Type | Individual
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Provider Name | SAMANTHA NICHOLE WATSON PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 11/27/2019
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Last Update Date | 11/27/2019
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Provider Practice Location Address
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Address Line | 4714 S US HIGHWAY 41
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City | TERRE HAUTE
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State | IN
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Zip | 47802-4413
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Country | US
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Telephone | 812-232-8379
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Fax | 812-232-8472
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Provider Business Mailing Address
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Address Line | 8787 BONO RD
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City | TERRE HAUTE
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State | IN
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Zip | 47802-8017
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Country | US
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Telephone | 217-508-3884
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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 | 051.300996
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License Number State | IL
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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 | 26027157A
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License Number State | IN
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