Provider Demographics
NPI:1003153065
Name:HANNOUSH, ASHLEY SUMMERS (PHARMD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:SUMMERS
Last Name:HANNOUSH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 PARKER RD SE
Mailing Address - Street 2:APARTMENT 322
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-2603
Mailing Address - Country:US
Mailing Address - Phone:404-983-4891
Mailing Address - Fax:
Practice Address - Street 1:2159 HIGHWAY 20 SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2028
Practice Address - Country:US
Practice Address - Phone:770-918-2506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist