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General NPI Number Information
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NPI Number | 1619985736
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Entity Type | Individual
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Provider Name | ROBERT BRENT WATERS RPH
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Gender | Male
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 11/29/2017
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Provider Practice Location Address
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Address Line | 1030 AVENUE D STE 2
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City | SNOHOMISH
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State | WA
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Zip | 98290-2086
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Country | US
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Telephone | 360-863-3009
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Fax | 844-375-4097
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Provider Business Mailing Address
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Address Line | 10330 MERIDIAN AVE N STE 180
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City | SEATTLE
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State | WA
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Zip | 98133-9496
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Country | US
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Telephone | 206-368-6060
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Fax | 206-368-6061
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | PH00011060
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License Number State | WA
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