Provider Demographics
NPI:1558648238
Name:WATSON, MARJORIE JANE (RPH)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:JANE
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 1:1215 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3515
Mailing Address - Country:US
Mailing Address - Phone:541-296-1748
Mailing Address - Fax:541-296-1756
Practice Address - Street 1:1215 W 6TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3515
Practice Address - Country:US
Practice Address - Phone:541-296-1748
Practice Address - Fax:541-296-1756
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0009936183500000X, 1835P0018X
WAPH 00019544183500000X
FLPS19726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist