Provider Demographics
NPI:1265867634
Name:WATSON, TAMRA JAE
Entity Type:Individual
Prefix:
First Name:TAMRA
Middle Name:JAE
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:993 PAXTON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-6742
Mailing Address - Country:US
Mailing Address - Phone:513-382-0608
Mailing Address - Fax:
Practice Address - Street 1:993 PAXTON LAKE DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-6742
Practice Address - Country:US
Practice Address - Phone:513-382-0608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-18890183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist