Provider Demographics
NPI:1346534435
Name:BLANCH, ASHLEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BLANCH
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 1:5700 OVERTON RIDGE BLVD
Mailing Address - Street 2:T1770
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3220
Mailing Address - Country:US
Mailing Address - Phone:817-423-1661
Mailing Address - Fax:817-423-1661
Practice Address - Street 1:5700 OVERTON RIDGE BLVD
Practice Address - Street 2:T1770
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3220
Practice Address - Country:US
Practice Address - Phone:817-423-1661
Practice Address - Fax:817-423-1661
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist