Provider Demographics
NPI:1437146347
Name:WATTS, JAMES ROBERT II (R PH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ROBERT
Last Name:WATTS
Suffix:II
Gender:M
Credentials:R PH
Other - Prefix:MR
Other - First Name:JAY
Other - Middle Name:ROBERT
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:R PH
Mailing Address - Street 1:333 NEWBERRY ST NW
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-3929
Mailing Address - Country:US
Mailing Address - Phone:803-599-1776
Mailing Address - Fax:803-649-7381
Practice Address - Street 1:333 NEWBERRY ST NW
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3929
Practice Address - Country:US
Practice Address - Phone:803-649-1776
Practice Address - Fax:803-641-0205
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6388183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC726932Medicaid
SCSC 6388OtherPHARMACIST LICENSE NUMBER
SCDME636Medicaid
SC57-0946943OtherFEDERAL TAX ID -MJW
SC4214627OtherNABP NUMBER-FAMILY PHARM
SC4225050OtherNABP -AIKEN COMPOUND PHAR
SC50-007327OtherPHCY LICENSE- AIKEN COMPD
SCSC 2693OtherFAMILY PHARMACY LIC #
SC4214627OtherNABP NUMBER-FAMILY PHARM
SC57-0946943OtherFEDERAL TAX ID -MJW
SCQ320060001Medicare PIN