Provider Demographics
NPI:1184716631
Name:WATSON, GLORIANN MARIE DALERE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GLORIANN
Middle Name:MARIE DALERE
Last Name:WATSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:GLORIANN
Other - Middle Name:MARIE
Other - Last Name:DALERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2256 HIKINO ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-2638
Mailing Address - Country:US
Mailing Address - Phone:808-744-2236
Mailing Address - Fax:
Practice Address - Street 1:459 PATTERSON ROAD
Practice Address - Street 2:DEPARTMENT OF VETERAN AFFAIRS PHARMACY
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819
Practice Address - Country:US
Practice Address - Phone:808-375-2924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 46416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist