Provider Demographics
NPI:1407179245
Name:WASHBURN, THOMAS W (PHARMD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:WASHBURN
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 1:189 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-3405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28 MADISON AVENUE EXT
Practice Address - Street 2:SUITE 3
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-5339
Practice Address - Country:US
Practice Address - Phone:518-951-2046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051751183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist