Provider Demographics
NPI:1447682737
Name:WATSON, TYLER JOSEPH (PHARMD)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:JOSEPH
Last Name:WATSON
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 1:303 91ST AVE NE
Mailing Address - Street 2:D401
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-2541
Mailing Address - Country:US
Mailing Address - Phone:425-335-4513
Mailing Address - Fax:425-334-7814
Practice Address - Street 1:303 91ST AVE NE
Practice Address - Street 2:D401
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-2541
Practice Address - Country:US
Practice Address - Phone:425-335-4513
Practice Address - Fax:425-334-7814
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60363797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist