Provider Demographics
NPI:1235748245
Name:SANTOS-WATTS, DEBORA (RPH)
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:
Last Name:SANTOS-WATTS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:DEBORA
Other - Middle Name:FONTES
Other - Last Name:MAMMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:55 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:NY
Mailing Address - Zip Code:10516-2604
Mailing Address - Country:US
Mailing Address - Phone:845-265-6352
Mailing Address - Fax:
Practice Address - Street 1:55 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:NY
Practice Address - Zip Code:10516-2604
Practice Address - Country:US
Practice Address - Phone:845-265-6352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-26
Last Update Date:2020-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist