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NPI Code Detail

MEDICARE: DAVID E WATTS RPH

MEDICARE: DAVID E 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
1183500000XPharmacist007291KY

General Provider Information

NPI Number : 1346520988
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID E WATTS RPH
Provider Business Mailing Address
First Line : 4001 MOEHERR CT
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-4485
Country : US
Telephone Number : 502-261-0758
Fax Number :
Provider Business Practice Location Address
First Line : 990 BAXTER AVE
Second Line :
City : LOUISVILLE
State : KY
Zip : 40204-2064
Country : US
Telephone Number : 502-585-3239
Fax Number : 502-583-3162
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2011
Last Update Date : 08/26/2011

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