Provider Demographics
NPI:1346520988
Name:WATTS, DAVID E (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:WATTS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 MOEHERR CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-4485
Mailing Address - Country:US
Mailing Address - Phone:502-261-0758
Mailing Address - Fax:
Practice Address - Street 1:990 BAXTER AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-2064
Practice Address - Country:US
Practice Address - Phone:502-585-3239
Practice Address - Fax:502-583-3162
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist