Provider Demographics
NPI:1073717914
Name:ASH, ELISE (RPH)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:ASH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 WHIPPOORWILL RD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-3625
Mailing Address - Country:US
Mailing Address - Phone:316-788-7002
Mailing Address - Fax:
Practice Address - Street 1:323 N ROSE HILL RD
Practice Address - Street 2:
Practice Address - City:ROSE HILL
Practice Address - State:KS
Practice Address - Zip Code:67133-9428
Practice Address - Country:US
Practice Address - Phone:316-776-1100
Practice Address - Fax:316-858-5281
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-12274183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist