Provider Demographics
NPI:1336503747
Name:WASHINGTON, DZICDZICE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DZICDZICE
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 LAKE ORANGE DRIVE
Mailing Address - Street 2:SUITE 190
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837
Mailing Address - Country:US
Mailing Address - Phone:407-493-4506
Mailing Address - Fax:
Practice Address - Street 1:2416 LAKE ORANGE DR
Practice Address - Street 2:SUITE 190
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7812
Practice Address - Country:US
Practice Address - Phone:407-493-4506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34380183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist