Provider Demographics
NPI:1376897066
Name:MUNDRICK, ASHLEY LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:LYNN
Last Name:MUNDRICK
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 1:3658 KNIGHT RD
Mailing Address - Street 2:
Mailing Address - City:SAUQUOIT
Mailing Address - State:NY
Mailing Address - Zip Code:13456-2504
Mailing Address - Country:US
Mailing Address - Phone:315-404-8154
Mailing Address - Fax:
Practice Address - Street 1:9553 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLLAND PATENT
Practice Address - State:NY
Practice Address - Zip Code:13354-3802
Practice Address - Country:US
Practice Address - Phone:315-865-8141
Practice Address - Fax:315-865-4318
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist