Provider Demographics
NPI:1649872094
Name:WASHINGTON, FAMOUS EVERETT SR (RPH)
Entity type:Individual
Prefix:
First Name:FAMOUS
Middle Name:EVERETT
Last Name:WASHINGTON
Suffix:SR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 TEXAS PT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-7737
Mailing Address - Country:US
Mailing Address - Phone:210-860-2534
Mailing Address - Fax:
Practice Address - Street 1:9427 CULEBRA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3599
Practice Address - Country:US
Practice Address - Phone:210-526-6007
Practice Address - Fax:210-526-6001
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38888183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist