Provider Demographics
NPI:1154084622
Name:WASHINGTON, TIANA NARAE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TIANA
Middle Name:NARAE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28425 N BLACK CANYON HWY UNIT 1085
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-7606
Mailing Address - Country:US
Mailing Address - Phone:602-736-1157
Mailing Address - Fax:
Practice Address - Street 1:28138 N TATUM BLVD
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-6303
Practice Address - Country:US
Practice Address - Phone:480-585-6097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS025505183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist