Provider Demographics
NPI:1942214499
Name:WATTS, KATHLEEN KNEBEL (RPH)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:KNEBEL
Last Name:WATTS
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 1:3000 ARROWHEAD TRL
Mailing Address - Street 2:
Mailing Address - City:MAIDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28650-8202
Mailing Address - Country:US
Mailing Address - Phone:828-428-8560
Mailing Address - Fax:704-263-1222
Practice Address - Street 1:110 E DALLAS RD
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:NC
Practice Address - Zip Code:28164-2051
Practice Address - Country:US
Practice Address - Phone:704-263-0810
Practice Address - Fax:704-263-1222
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist