Provider Demographics
NPI:1144749524
Name:MOULTON, ASHLEY J (PHARMD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:J
Last Name:MOULTON
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 1:182 BACK RD
Mailing Address - Street 2:
Mailing Address - City:ALFRED
Mailing Address - State:ME
Mailing Address - Zip Code:04002-3226
Mailing Address - Country:US
Mailing Address - Phone:207-651-8937
Mailing Address - Fax:
Practice Address - Street 1:37 PORTLAND RD
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6628
Practice Address - Country:US
Practice Address - Phone:207-985-7144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-17
Last Update Date:2017-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR46824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist