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NPI Code Detail

MEDICARE: DR. JUSTIN WATERSON PHARMD

MEDICARE: DR. JUSTIN WATERSON 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
1183500000XPharmacist4246WY

General Provider Information

NPI Number : 1790396125
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUSTIN WATERSON PHARMD
Provider Business Mailing Address
First Line : 431 FORT ST
Second Line :
City : BUFFALO
State : WY
Zip : 82834-1805
Country : US
Telephone Number : 307-684-7003
Fax Number : 307-684-7348
Provider Business Practice Location Address
First Line : 431 FORT ST
Second Line :
City : BUFFALO
State : WY
Zip : 82834-1805
Country : US
Telephone Number : 307-684-7003
Fax Number : 307-684-7348
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2020
Last Update Date : 08/10/2020

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Directions to “ DR. JUSTIN WATERSON PHARMD” Practice Location

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