Provider Demographics
NPI:1447279518
Name:WATTS, PAUL WILLIAM (PHARMD)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:WILLIAM
Last Name:WATTS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 CAPELA WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-4524
Mailing Address - Country:US
Mailing Address - Phone:916-213-4215
Mailing Address - Fax:916-392-0247
Practice Address - Street 1:5342 DUDLEY BLVD
Practice Address - Street 2:
Practice Address - City:MCCLELLAN
Practice Address - State:CA
Practice Address - Zip Code:95652-1012
Practice Address - Country:US
Practice Address - Phone:916-561-7430
Practice Address - Fax:916-561-7475
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH4720183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH4720OtherPHARMACY LICENSE