Provider Demographics
NPI:1295386290
Name:WADE, ASHLEY DAWN (PHARM D)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DAWN
Last Name:WADE
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 1:1749 W CAMPBELL RD APT 8302
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-2390
Mailing Address - Country:US
Mailing Address - Phone:501-712-8720
Mailing Address - Fax:
Practice Address - Street 1:1749 W CAMPBELL RD APT 8302
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-2390
Practice Address - Country:US
Practice Address - Phone:501-712-8720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist