Provider Demographics
NPI:1215121553
Name:WATTIGNY, BETH ANN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:ANN
Last Name:WATTIGNY
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 1:4910 I 55 N
Mailing Address - Street 2:KROGER PHARMACY #345
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-5401
Mailing Address - Country:US
Mailing Address - Phone:601-366-6554
Mailing Address - Fax:601-366-7673
Practice Address - Street 1:4910 I 55 N
Practice Address - Street 2:KROGER PHARMACY #345
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-5401
Practice Address - Country:US
Practice Address - Phone:601-366-6554
Practice Address - Fax:601-366-7673
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-09706183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist