Provider Demographics
NPI:1710575352
Name:WATKINS, DEBORAH ANN
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:WATKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26075 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872-1831
Mailing Address - Country:US
Mailing Address - Phone:301-253-9418
Mailing Address - Fax:301-482-1179
Practice Address - Street 1:26075 RIDGE RD
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872-1831
Practice Address - Country:US
Practice Address - Phone:301-253-9418
Practice Address - Fax:301-482-1179
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT06873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist