Provider Demographics
NPI:1649697798
Name:WATTENBARGER, STEVEN CODY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:CODY
Last Name:WATTENBARGER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 STATE HIGHWAY 68 E
Mailing Address - Street 2:
Mailing Address - City:TEN MILE
Mailing Address - State:TN
Mailing Address - Zip Code:37880-4245
Mailing Address - Country:US
Mailing Address - Phone:423-506-5921
Mailing Address - Fax:
Practice Address - Street 1:7971 RHEA COUNTY HWY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-5924
Practice Address - Country:US
Practice Address - Phone:423-775-2163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37713183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist