Provider Demographics
NPI:1427326123
Name:WATTERSON, DANIEL LEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LEE
Last Name:WATTERSON
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 1:17612 N 59TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3795
Mailing Address - Country:US
Mailing Address - Phone:602-942-8270
Mailing Address - Fax:602-942-2975
Practice Address - Street 1:17612 N 59TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3795
Practice Address - Country:US
Practice Address - Phone:602-942-8270
Practice Address - Fax:602-942-2975
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist