Provider Demographics
NPI:1053869503
Name:WATTS, RYAN P (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:P
Last Name:WATTS
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 1:680 CRANE CREEK DR
Mailing Address - Street 2:APRT 228
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-3075
Mailing Address - Country:US
Mailing Address - Phone:513-238-2467
Mailing Address - Fax:
Practice Address - Street 1:3510 RICHLAND AVE W
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6312
Practice Address - Country:US
Practice Address - Phone:513-238-2467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2016-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36848183500000X
VA0202214402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist