Provider Demographics
NPI:1225175052
Name:R. B. WATSON PHARMACY, INC.
Entity Type:Organization
Organization Name:R. B. WATSON PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYNN
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEFILS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-635-4568
Mailing Address - Street 1:16 W WALL ST
Mailing Address - Street 2:
Mailing Address - City:FROSTPROOF
Mailing Address - State:FL
Mailing Address - Zip Code:33843-2042
Mailing Address - Country:US
Mailing Address - Phone:863-635-4568
Mailing Address - Fax:863-635-7107
Practice Address - Street 1:16 W WALL ST
Practice Address - Street 2:
Practice Address - City:FROSTPROOF
Practice Address - State:FL
Practice Address - Zip Code:33843-2042
Practice Address - Country:US
Practice Address - Phone:863-635-4568
Practice Address - Fax:863-635-7107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101500102Medicaid
FL0164060001Medicare NSC