Provider Demographics
NPI:1568738946
Name:WATSON, TANEESHA RENE' (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TANEESHA
Middle Name:RENE'
Last Name:WATSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 WEST THIRD ST
Mailing Address - Street 2:DAYTON VAMC
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45428
Mailing Address - Country:US
Mailing Address - Phone:937-268-6511
Mailing Address - Fax:
Practice Address - Street 1:4100 WEST THIRD ST (119)
Practice Address - Street 2:DAYTON VAMC
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428-9998
Practice Address - Country:US
Practice Address - Phone:937-268-6511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRPH.03228310-21835P0018X
GARPH0233411835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist