Provider Demographics
NPI:1275139743
Name:WATKE, FREDERIC ROBERT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:ROBERT
Last Name:WATKE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 S AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6700
Mailing Address - Country:US
Mailing Address - Phone:512-863-2581
Mailing Address - Fax:
Practice Address - Street 1:1102 S AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-6700
Practice Address - Country:US
Practice Address - Phone:512-863-2581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP454715183500000X
COPHA.0023215183500000X
WAPH61090511183500000X
TX68004183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist