Active NPI
Robert Brent Waters, RPH
- Pharmacotherapy Pharmacist
- Snohomish, WA
National Provider Identifier
1619985736
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacotherapy Pharmacist
- License
- PH00011060
- Practice address
- 1030 Avenue D Ste 2
Snohomish, WA 98290-2086 - Phone
- (360) 863-3009
- Fax
- (844) 375-4097
- NPI assigned
- Aug 4, 2006
- Last updated
- Nov 29, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacotherapy Pharmacist | 1835P1200X | PH00011060 | WA | Primary |
Addresses
Primary practice location
1030 Avenue D Ste 2
Snohomish, WA 98290-2086
Mailing address
10330 Meridian Ave N Ste 180
Seattle, WA 98133-9496
Phone (206) 368-6060
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH00011060 | WA | MD | Pharmacotherapy Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Matrx Pharmacy, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1511913600000",
"number": "1619985736",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10330 MERIDIAN AVE N STE 180",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981339496",
"telephone_number": "206-368-6060",
"fax_number": "206-368-6061"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1030 AVENUE D STE 2",
"city": "SNOHOMISH",
"state": "WA",
"postal_code": "982902086",
"telephone_number": "360-863-3009",
"fax_number": "844-375-4097"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATERS",
"first_name": "ROBERT",
"middle_name": "BRENT",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-04",
"last_updated": "2017-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "1835P1200X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacotherapy",
"state": "WA",
"license": "PH00011060",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Snohomish, WA
- Rosa Lee Wapstra, RN, MS
- Washington CVS Pharmacy LLC (CVS Pharmacy #11652)
- Washington Dental Corporation PC (Snohomish Modern Dentistry)
- Washington Ya Services LLC (Newport Institute-Railroad)
- Washintgon Ya Services LLC (Newport Institute-Echo Lake)
- Sara Wees
- Kayla Marie Weiderstrom, LMT
- Bailey Wells
- Joan M West, LMT
- Nichole Renee West, LMP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.