Provider Demographics
NPI:1205404662
Name:WATERS, GERALYN (PHARMD)
Entity Type:Individual
Prefix:
First Name:GERALYN
Middle Name:
Last Name:WATERS
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 1:112 ROBERTS LAKE CIR APT 202
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-0496
Mailing Address - Country:US
Mailing Address - Phone:804-420-5226
Mailing Address - Fax:
Practice Address - Street 1:1830 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-3207
Practice Address - Country:US
Practice Address - Phone:804-420-5226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233271183500000X
VA0202209951183500000X
NC31173183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist