Provider Demographics
NPI:1275360547
Name:WATERSTON, MEGHAN LOU (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:LOU
Last Name:WATERSTON
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 1:5006 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-2340
Mailing Address - Country:US
Mailing Address - Phone:865-688-1812
Mailing Address - Fax:
Practice Address - Street 1:5006 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-2340
Practice Address - Country:US
Practice Address - Phone:478-957-3316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48195183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist