Provider Demographics
NPI:1518570829
Name:WATSON, KRESTON ALAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRESTON
Middle Name:ALAN
Last Name:WATSON
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 1:2015 SPARKMAN DR NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35810-3815
Mailing Address - Country:US
Mailing Address - Phone:256-715-7475
Mailing Address - Fax:256-715-7418
Practice Address - Street 1:2015 SPARKMAN DR NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35810-3815
Practice Address - Country:US
Practice Address - Phone:256-715-7475
Practice Address - Fax:256-715-7418
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q003930001OtherPTAN