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General NPI Number Information
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NPI Number | 1912514449
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Entity Type | Individual
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Provider Name | JESSICA WATTS PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/29/2020
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Last Update Date | 05/20/2022
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Provider Practice Location Address
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Address Line | 7400 MERTON MINTER BLVD
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City | SAN ANTONIO
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State | TX
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Zip | 78229
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Country | US
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Telephone | 210-617-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 3361 PICKET FENCE LN
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City | MYRTLE BEACH
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State | SC
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Zip | 29579-3310
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Country | US
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Telephone | 732-616-9409
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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 | 42535
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License Number State | SC
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