Provider Demographics
NPI:1548749211
Name:HOLCOMB, ASHLEY BRYANT (PHARMD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BRYANT
Last Name:HOLCOMB
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:PO BOX 410
Mailing Address - Street 2:
Mailing Address - City:FYFFE
Mailing Address - State:AL
Mailing Address - Zip Code:35971-0410
Mailing Address - Country:US
Mailing Address - Phone:256-638-6667
Mailing Address - Fax:256-638-6658
Practice Address - Street 1:1248 MAIN ST
Practice Address - Street 2:
Practice Address - City:FYFFE
Practice Address - State:AL
Practice Address - Zip Code:35971-3471
Practice Address - Country:US
Practice Address - Phone:256-638-6667
Practice Address - Fax:256-638-6658
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100003112Medicaid