Robert Brent Waters, RPH

Primary specialty

Pharmacotherapy PharmacistTaxonomy code 1835P1200X

License

PH00011060 Issued in WA

Practice address

1030 Avenue D Ste 2
Snohomish, WA 98290-2086

Phone

(360) 863-3009

Fax

(844) 375-4097

NPI assigned

Aug 4, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Matrx Pharmacy, LLC

  • Long Term Care Pharmacy
  • Snohomish, WA
  • NPI 1700223526
  NPD (past)

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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "003118",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "91-1996749",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6010938",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rosa Lee Wapstra, RN, MS
• Washington CVS Pharmacy LLC
• Washington Dental Corporation PC
• Washington Ya Services LLC
• Washintgon Ya Services LLC
• Sara Wees
• Kayla Marie Weiderstrom, LMT
• Bailey Wells
• Joan M West, LMT
• Nichole Renee West, LMP

• Pharmacotherapy Pharmacist in Snohomish, WA
• Providers in Snohomish, WA by specialty
• Pharmacotherapy Pharmacist in Washington

• 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.

Verify at the official NPI Registry.