Provider Demographics
NPI:1174832877
Name:WATTS, KATIE (RPH)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:WATTS
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 1:3311 CANOE BROOK PKWY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8687
Mailing Address - Country:US
Mailing Address - Phone:919-449-2489
Mailing Address - Fax:
Practice Address - Street 1:13304 LEESVILLE CHURCH RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-5206
Practice Address - Country:US
Practice Address - Phone:919-845-2489
Practice Address - Fax:919-845-5198
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10510183500000X
SC9840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist