Provider Demographics
NPI:1093832461
Name:WATSONS PHARMACY
Entity Type:Organization
Organization Name:WATSONS PHARMACY
Other - Org Name:CAMERONS PAWTUXET PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANOSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-781-1313
Mailing Address - Street 1:2206 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3332
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2206 BROAD ST
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02905-3332
Practice Address - Country:US
Practice Address - Phone:401-781-1313
Practice Address - Fax:401-781-4309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
RIPHA003653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4100563OtherOTHER ID NUMBER-COMMERCIAL NUMBER
4100563OtherOTHER ID NUMBER
RICP00381Medicaid