Provider Demographics
NPI:1093303448
Name:WATSON, LISA MCBROOM (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MCBROOM
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 1:132 STEEL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-7018
Mailing Address - Country:US
Mailing Address - Phone:361-441-3277
Mailing Address - Fax:
Practice Address - Street 1:910 RIVER RD STE 103
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2441
Practice Address - Country:US
Practice Address - Phone:830-816-5384
Practice Address - Fax:830-331-7405
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist