Provider Demographics
NPI:1487982765
Name:WATSON PHARMACY INC
Entity type:Organization
Organization Name:WATSON PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:GAZALEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-504-2100
Mailing Address - Street 1:PO BOX 24569
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32241-4569
Mailing Address - Country:US
Mailing Address - Phone:904-619-5523
Mailing Address - Fax:904-619-5527
Practice Address - Street 1:8058 OLD KINGS RD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4102
Practice Address - Country:US
Practice Address - Phone:904-619-5523
Practice Address - Fax:904-619-5527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH243583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1051274OtherNCPDP PROVIDER IDENTIFICATION NUMBER