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General NPI Number Information
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NPI Number | 1215485628
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Entity Type | Individual
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Provider Name | DEBRA WATSON
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Gender | Female
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 300 LAFAYETTE AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4692
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Country | US
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Telephone | 616-685-6105
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Fax |
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Provider Business Mailing Address
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Address Line | 7264 TYLER PINES AVE
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City | HUDSONVILLE
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State | MI
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Zip | 49426-9793
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Country | US
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Telephone | 616-669-1997
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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 | 5302025143
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License Number State | MI
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