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General NPI Number Information
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NPI Number | 1326619438
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Entity Type | Individual
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Provider Name | BRANDON TYLER WATSON
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Gender | Male
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Dates
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Enumeration Date | 07/09/2021
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Last Update Date | 07/09/2021
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Provider Practice Location Address
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Address Line | 2200 VILLAGE DR
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City | MOODY
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State | AL
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Zip | 35004-3241
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Country | US
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Telephone | 205-640-3237
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Fax |
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Provider Business Mailing Address
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Address Line | 8604 HIGHLANDS TRCE
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City | TRUSSVILLE
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State | AL
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Zip | 35173-3819
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Country | US
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Telephone | 205-612-5450
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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 | 21956
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License Number State | AL
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