Provider Demographics
NPI:1457508285
Name:WATSON, CECILIA JACOMINA (RPH)
Entity Type:Individual
Prefix:MISS
First Name:CECILIA
Middle Name:JACOMINA
Last Name:WATSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 E AVENUE J
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-3840
Mailing Address - Country:US
Mailing Address - Phone:661-948-9620
Mailing Address - Fax:661-948-1309
Practice Address - Street 1:1010 E AVENUE J
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-3840
Practice Address - Country:US
Practice Address - Phone:661-948-9620
Practice Address - Fax:661-948-1309
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA48085OtherCA RPH LICENSE #