Provider Demographics
NPI:1568618486
Name:WATTERS, JILL MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:WATTERS
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 1:2525 9TH AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-2014
Mailing Address - Country:US
Mailing Address - Phone:814-300-2273
Mailing Address - Fax:814-800-1021
Practice Address - Street 1:2525 9TH AVE STE 2B
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-2014
Practice Address - Country:US
Practice Address - Phone:814-300-2273
Practice Address - Fax:814-800-1021
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038540L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist