Provider Demographics
NPI:1083155675
Name:PETERS, ASHLEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:PETERS
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 1:2721 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:NY
Mailing Address - Zip Code:12928-2607
Mailing Address - Country:US
Mailing Address - Phone:518-572-7642
Mailing Address - Fax:
Practice Address - Street 1:40 SKYWAY SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-3873
Practice Address - Country:US
Practice Address - Phone:518-561-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060236183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist