Provider Demographics
NPI:1033634753
Name:UNZICKER, ASHLEY ELAINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ELAINE
Last Name:UNZICKER
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 1:761 WALKER RD APT B
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3673
Mailing Address - Country:US
Mailing Address - Phone:309-208-2591
Mailing Address - Fax:
Practice Address - Street 1:3144 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3483
Practice Address - Country:US
Practice Address - Phone:731-660-3335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist