Provider Demographics
NPI:1063717601
Name:WATSON, REBECCA HEAVNER (RPH)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:HEAVNER
Last Name:WATSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 US HIGHWAY 70A E
Mailing Address - Street 2:
Mailing Address - City:HILDEBRAN
Mailing Address - State:NC
Mailing Address - Zip Code:28637-8108
Mailing Address - Country:US
Mailing Address - Phone:828-397-7479
Mailing Address - Fax:828-397-2031
Practice Address - Street 1:200 US HIGHWAY 70A E
Practice Address - Street 2:
Practice Address - City:HILDEBRAN
Practice Address - State:NC
Practice Address - Zip Code:28637-8108
Practice Address - Country:US
Practice Address - Phone:828-397-7479
Practice Address - Fax:828-397-2031
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11355183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist