Provider Demographics
NPI:1598350035
Name:BURNETT, ASHLEY N (PHARMD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:N
Last Name:BURNETT
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 1:21303 STATE ROUTE 81
Mailing Address - Street 2:
Mailing Address - City:SPENCERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45887-9039
Mailing Address - Country:US
Mailing Address - Phone:419-890-5422
Mailing Address - Fax:
Practice Address - Street 1:950 W VOTAW ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:IN
Practice Address - Zip Code:47371-1254
Practice Address - Country:US
Practice Address - Phone:260-726-3682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-06
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCV2100016183500000X
OH03135717183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist