Provider Demographics
NPI:1487936662
Name:WATSON, MARCY MICHELLE (RPH)
Entity type:Individual
Prefix:
First Name:MARCY
Middle Name:MICHELLE
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 1:3700 FRANKFORT AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2557
Mailing Address - Country:US
Mailing Address - Phone:502-899-9353
Mailing Address - Fax:502-899-9441
Practice Address - Street 1:3700 FRANKFORT AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2557
Practice Address - Country:US
Practice Address - Phone:502-899-9353
Practice Address - Fax:502-899-9441
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0118261835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist