Provider Demographics
NPI:1023110723
Name:WATSON, MICHAEL E (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:WATSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SAINT GILES RD
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-3704
Mailing Address - Country:US
Mailing Address - Phone:561-422-8248
Mailing Address - Fax:561-422-5378
Practice Address - Street 1:7305 N MILITARY TRL
Practice Address - Street 2:MAIL CODE 119
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-7417
Practice Address - Country:US
Practice Address - Phone:561-422-7205
Practice Address - Fax:561-422-5378
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist