Provider Demographics
NPI:1649549833
Name:WATSON, JOVIAL (PHARMD)
Entity type:Individual
Prefix:MISS
First Name:JOVIAL
Middle Name:
Last Name:WATSON
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 1:38 HOMESTEAD RD N
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-6646
Mailing Address - Country:US
Mailing Address - Phone:239-368-7186
Mailing Address - Fax:239-368-9607
Practice Address - Street 1:38 HOMESTEAD RD N
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6646
Practice Address - Country:US
Practice Address - Phone:239-368-7186
Practice Address - Fax:239-368-9607
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42697183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist