Provider Demographics
NPI:1871903328
Name:WATSON, JENNIFER (RPH)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5325 E SOUTHPORT RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-9336
Mailing Address - Country:US
Mailing Address - Phone:317-859-2210
Mailing Address - Fax:317-859-2265
Practice Address - Street 1:5325 E SOUTHPORT RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-9336
Practice Address - Country:US
Practice Address - Phone:317-859-2210
Practice Address - Fax:317-859-2265
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019965A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26019965AOtherPHARMACIST LICENSE