Provider Demographics
NPI:1174720064
Name:WASHINGTON, GWENDOLYN S (RPH)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:S
Last Name:WASHINGTON
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 1:2612 GRANADA CIR W
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-3930
Mailing Address - Country:US
Mailing Address - Phone:727-742-3543
Mailing Address - Fax:
Practice Address - Street 1:2612 GRANADA CIR W
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-3930
Practice Address - Country:US
Practice Address - Phone:727-742-3543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH0012344183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist