Provider Demographics
NPI:1780088807
Name:WASHINGTON, MAURICE SHERVETTE
Entity type:Individual
Prefix:MISS
First Name:MAURICE
Middle Name:SHERVETTE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4234 E SHADOW BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85756-3094
Mailing Address - Country:US
Mailing Address - Phone:239-671-5026
Mailing Address - Fax:
Practice Address - Street 1:3925 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2506
Practice Address - Country:US
Practice Address - Phone:520-327-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS020915183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist