Provider Demographics
NPI:1184225955
Name:BOLTON, ASHLEY MARIE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:MARIE
Last Name:BOLTON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12499 STATE ROUTE 21
Mailing Address - Street 2:
Mailing Address - City:DE SOTO
Mailing Address - State:MO
Mailing Address - Zip Code:63020-3317
Mailing Address - Country:US
Mailing Address - Phone:636-209-3209
Mailing Address - Fax:
Practice Address - Street 1:12862 STATE ROUTE 21
Practice Address - Street 2:
Practice Address - City:DE SOTO
Practice Address - State:MO
Practice Address - Zip Code:63020-4742
Practice Address - Country:US
Practice Address - Phone:636-209-3206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015027465183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist