Provider Demographics
NPI:1669587721
Name:WATSON, BRIAN (PHARMD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:WATSON
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 1:2205 BYRNES CT
Mailing Address - Street 2:APT. G
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6738
Mailing Address - Country:US
Mailing Address - Phone:443-350-4535
Mailing Address - Fax:
Practice Address - Street 1:4755 OGLETOWN-STANTON RD
Practice Address - Street 2:SUITE L022
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-0001
Practice Address - Country:US
Practice Address - Phone:302-733-6364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12805183500000X
DEA1-0003542183500000X
MD17947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist