Provider Demographics
NPI:1558845115
Name:DUNHAM, ASHLI (PHARMD)
Entity Type:Individual
Prefix:
First Name:ASHLI
Middle Name:
Last Name:DUNHAM
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 1:3379 130TH ST
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:IA
Mailing Address - Zip Code:51529-4009
Mailing Address - Country:US
Mailing Address - Phone:712-269-9983
Mailing Address - Fax:
Practice Address - Street 1:3201 MANAWA CENTRE DR
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-7672
Practice Address - Country:US
Practice Address - Phone:712-366-1315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16203183500000X
IA23382183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist