Provider Demographics
NPI:1184228637
Name:WATSON, HEATHER (PHARMD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4354 NW 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6541
Mailing Address - Country:US
Mailing Address - Phone:352-376-4565
Mailing Address - Fax:352-376-1424
Practice Address - Street 1:4354 NW 23RD AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6541
Practice Address - Country:US
Practice Address - Phone:352-376-4565
Practice Address - Fax:352-376-1424
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35757183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist