Provider Demographics
NPI:1417209321
Name:WATTS, SCOTT E (RPH)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
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 1:9101 MENDENHALL MALL RD
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7113
Mailing Address - Country:US
Mailing Address - Phone:907-789-0458
Mailing Address - Fax:907-789-1356
Practice Address - Street 1:9101 MENDENHALL MALL RD
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7113
Practice Address - Country:US
Practice Address - Phone:907-789-0458
Practice Address - Fax:907-789-1356
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK899183500000X
WAPH 00015123183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist