Provider Demographics
NPI:1598174302
Name:VANVLECK, ASHLEY LYNETTE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LYNETTE
Last Name:VANVLECK
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 510
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:ID
Mailing Address - Zip Code:83869-0510
Mailing Address - Country:US
Mailing Address - Phone:208-623-8485
Mailing Address - Fax:
Practice Address - Street 1:31964 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:ID
Practice Address - Zip Code:83869
Practice Address - Country:US
Practice Address - Phone:208-623-8485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60468269183500000X
IDP7104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist