Provider Demographics
NPI:1225319775
Name:ASH, AUDRA (PHARM D)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:ASH
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 1:600 SHAWNEE MALL DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1322
Mailing Address - Country:US
Mailing Address - Phone:405-878-1437
Mailing Address - Fax:405-878-1196
Practice Address - Street 1:600 SHAWNEE MALL DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1322
Practice Address - Country:US
Practice Address - Phone:405-878-1437
Practice Address - Fax:405-878-1196
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12534183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist