Provider Demographics
NPI:1528335437
Name:WATKINS, SARAH
Entity type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5418 VENETIAN WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-4511
Mailing Address - Country:US
Mailing Address - Phone:769-216-3409
Mailing Address - Fax:
Practice Address - Street 1:1100 HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-9088
Practice Address - Country:US
Practice Address - Phone:601-853-2088
Practice Address - Fax:601-853-7408
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-20
Last Update Date:2011-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07532183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist