Provider Demographics
NPI:1093389116
Name:BRADSHAW, ASHLEY ALISA (RPH)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ALISA
Last Name:BRADSHAW
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 1:6014 183RD ST NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-6913
Mailing Address - Country:US
Mailing Address - Phone:425-622-6294
Mailing Address - Fax:
Practice Address - Street 1:1115 13TH ST
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2012
Practice Address - Country:US
Practice Address - Phone:360-568-4153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00000001835P0018X
WAPH61183666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist