Provider Demographics
NPI:1073043543
Name:SPENCER, ASHTON LEE BOOTH (PHARMD)
Entity Type:Individual
Prefix:
First Name:ASHTON
Middle Name:LEE BOOTH
Last Name:SPENCER
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 1:12197 SUNSET HILLS RD
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3208
Mailing Address - Country:US
Mailing Address - Phone:703-478-9698
Mailing Address - Fax:
Practice Address - Street 1:12197 SUNSET HILLS RD
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3208
Practice Address - Country:US
Practice Address - Phone:703-478-9698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202212603183500000X
NHR2766183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist