Provider Demographics
NPI:1477030708
Name:FLEMING, ASHLEY
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:FLEMING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 FREEPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:DE FUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32433
Mailing Address - Country:US
Mailing Address - Phone:850-892-6914
Mailing Address - Fax:850-892-0827
Practice Address - Street 1:1226 FREEPORT ROAD
Practice Address - Street 2:
Practice Address - City:DE FUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32433
Practice Address - Country:US
Practice Address - Phone:850-892-6914
Practice Address - Fax:850-892-0827
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL710862119Medicaid