Provider Demographics
NPI:1073251476
Name:HETZER, ASHLEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:
Last Name:HETZER
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 1:4809 TARRAGONA LN
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6878
Mailing Address - Country:US
Mailing Address - Phone:832-738-8185
Mailing Address - Fax:
Practice Address - Street 1:1295 E LEAGUE CITY PKWY
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-6025
Practice Address - Country:US
Practice Address - Phone:281-332-8290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48861183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist