Provider Demographics
NPI:1083788343
Name:WATERS, WESLEY V III (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:V
Last Name:WATERS
Suffix:III
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 THORNHILL WAY
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-3649
Mailing Address - Country:US
Mailing Address - Phone:919-444-1288
Mailing Address - Fax:919-542-7220
Practice Address - Street 1:628 EAST STREET
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312
Practice Address - Country:US
Practice Address - Phone:910-673-7467
Practice Address - Fax:910-673-3595
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16414183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist