Provider Demographics
NPI:1619251956
Name:WASHINGTON, LILETTA TROY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LILETTA
Middle Name:TROY
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 1:2815 N ASHLEY ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1806
Mailing Address - Country:US
Mailing Address - Phone:229-253-9069
Mailing Address - Fax:229-253-9621
Practice Address - Street 1:2815 N ASHLEY ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1806
Practice Address - Country:US
Practice Address - Phone:229-253-9069
Practice Address - Fax:229-253-9621
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA21800183500000X
FL30551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist