Provider Demographics
NPI:1356955470
Name:WASHINGTON, CLINTON E (PHARM D)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:E
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 1:524 PATRIOT PLACE DR
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65742-6527
Mailing Address - Country:US
Mailing Address - Phone:417-274-8168
Mailing Address - Fax:
Practice Address - Street 1:210 HIGHWAY 165
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-3464
Practice Address - Country:US
Practice Address - Phone:417-339-3996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017026037183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist