Provider Demographics
NPI:1760764765
Name:WASHINGTON, LAKEISHA (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:LAKEISHA
Other - Middle Name:WASHIGNTON
Other - Last Name:AXEM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12404 SW 215TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-5963
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5101 NW 21ST AVE
Practice Address - Street 2:SUITE 530
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2792
Practice Address - Country:US
Practice Address - Phone:954-739-4115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37960183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist