MEDICARE: DR. NICHOLAS BRADFORD WATTS PHARMD

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
1	183500000X	Pharmacist	24133	NC

General Provider Information

NPI Number	:	1659785087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS BRADFORD WATTS PHARMD

Provider Business Mailing Address
First Line	:	PO BOX 537
Second Line	:	317 NORTH MAIN STREET
City	:	WALNUT COVE
State	:	NC
Zip	:	27052-0537
Country	:	US
Telephone Number	:	336-591-7171
Fax Number	:	336-591-7936

Provider Business Practice Location Address
First Line	:	317 N MAIN ST
Second Line	:
City	:	WALNUT COVE
State	:	NC
Zip	:	27052-9200
Country	:	US
Telephone Number	:	336-591-7171
Fax Number	:	336-591-7936

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2014
Last Update Date	:	06/13/2014

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