Provider Demographics
NPI:1962996694
Name:WASHINGTON, MARY L (PHARMD, BS CHEM)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:L
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:PHARMD, BS CHEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4127 FOREMAN WAY
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-4758
Mailing Address - Country:US
Mailing Address - Phone:706-564-6092
Mailing Address - Fax:
Practice Address - Street 1:4127 FOREMAN WAY
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-4758
Practice Address - Country:US
Practice Address - Phone:706-564-6092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH028878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist