Healthcare Provider Details

I. General information

NPI: 1467096909
Provider Name (Legal Business Name): CORRIE WORSHAM WASHBURN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 BROADWAY ST
ALAMO HEIGHTS TX
78209-4545
US

IV. Provider business mailing address

23918 CALICO CHASE
SAN ANTONIO TX
78260-6645
US

V. Phone/Fax

Practice location:
  • Phone: 210-824-3322
  • Fax:
Mailing address:
  • Phone: 210-663-4104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number58586
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: