Provider Demographics
NPI:1639546161
Name:WATT, TINA MARIE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:MARIE
Last Name:WATT
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-6989
Mailing Address - Country:US
Mailing Address - Phone:308-432-6999
Mailing Address - Fax:308-432-3064
Practice Address - Street 1:510 LINDEN ST
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337-6989
Practice Address - Country:US
Practice Address - Phone:308-432-6999
Practice Address - Fax:308-432-3064
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13189183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist