Provider Demographics
NPI:1538448659
Name:WATTS, CELESTE R (RPH)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:R
Last Name:WATTS
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 1:841 HIGHWAY 411 N
Mailing Address - Street 2:
Mailing Address - City:ETOWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37331-1913
Mailing Address - Country:US
Mailing Address - Phone:423-263-5481
Mailing Address - Fax:423-263-5261
Practice Address - Street 1:841 HIGHWAY 411 N
Practice Address - Street 2:
Practice Address - City:ETOWAH
Practice Address - State:TN
Practice Address - Zip Code:37331-1913
Practice Address - Country:US
Practice Address - Phone:423-263-5481
Practice Address - Fax:423-263-5261
Is Sole Proprietor?:No
Enumeration Date:2011-08-07
Last Update Date:2011-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8566183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist