Provider Demographics
NPI:1013252576
Name:WHITESIDES-WATKINS, CICELY R (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CICELY
Middle Name:R
Last Name:WHITESIDES-WATKINS
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:P.O. BOX 84052
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073
Mailing Address - Country:US
Mailing Address - Phone:803-429-7720
Mailing Address - Fax:706-739-1702
Practice Address - Street 1:1313 WATERS EDGE DRIVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901
Practice Address - Country:US
Practice Address - Phone:706-869-5197
Practice Address - Fax:706-739-1702
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-10
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021982183500000X
FLPS56162183500000X
NC18489183500000X
SC10646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist