Provider Demographics
NPI:1184100604
Name:WASHINGTON, GABRIEL ALLEN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:ALLEN
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 DORSETT VLG
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-2208
Mailing Address - Country:US
Mailing Address - Phone:314-434-5496
Mailing Address - Fax:
Practice Address - Street 1:2030 DORSETT VLG
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-2208
Practice Address - Country:US
Practice Address - Phone:314-434-5496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012025446183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist