Provider Demographics
NPI:1225635626
Name:ASONG, GLADYS (PHARMD, PHD)
Entity Type:Individual
Prefix:DR
First Name:GLADYS
Middle Name:
Last Name:ASONG
Suffix:
Gender:F
Credentials:PHARMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 WHIPPOORWILL SPRINGS DR #1389
Mailing Address - Street 2:UNIT 1
Mailing Address - City:PINON
Mailing Address - State:AZ
Mailing Address - Zip Code:86510-1389
Mailing Address - Country:US
Mailing Address - Phone:850-339-5906
Mailing Address - Fax:
Practice Address - Street 1:NAVAJO ROUTE 4
Practice Address - Street 2:
Practice Address - City:PINON
Practice Address - State:AZ
Practice Address - Zip Code:86510
Practice Address - Country:US
Practice Address - Phone:928-725-9514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS48009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist