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General NPI Number Information
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NPI Number | 1356955470
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Entity Type | Individual
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Provider Name | CLINTON E. WASHINGTON PHARM. D
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Gender | Male
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 210 HIGHWAY 165
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City | BRANSON
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State | MO
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Zip | 65616-3464
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Country | US
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Telephone | 417-339-3996
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Fax |
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Provider Business Mailing Address
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Address Line | 524 PATRIOT PLACE DR
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City | ROGERSVILLE
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State | MO
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Zip | 65742-6527
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Country | US
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Telephone | 417-274-8168
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2017026037
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License Number State | MO
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