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NPI Code Detail

MEDICARE: KATIE WATTS RPH

MEDICARE: KATIE WATTS RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist10510NC
2183500000XPharmacist9840SC

General Provider Information

NPI Number : 1174832877
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATIE WATTS RPH
Provider Business Mailing Address
First Line : 3311 CANOE BROOK PKWY
Second Line :
City : RALEIGH
State : NC
Zip : 27614-8687
Country : US
Telephone Number : 919-449-2489
Fax Number :
Provider Business Practice Location Address
First Line : 13304 LEESVILLE CHURCH RD
Second Line :
City : RALEIGH
State : NC
Zip : 27617-5206
Country : US
Telephone Number : 919-845-2489
Fax Number : 919-845-5198
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2010
Last Update Date : 09/28/2010

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