Provider Demographics
NPI:1629762315
Name:ROBERTS, ASHLYNN NICOLE (CPHT)
Entity Type:Individual
Prefix:
First Name:ASHLYNN
Middle Name:NICOLE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CPHT
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 1077
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:VA
Mailing Address - Zip Code:24171-1077
Mailing Address - Country:US
Mailing Address - Phone:276-694-4034
Mailing Address - Fax:276-694-8355
Practice Address - Street 1:2508 DOGWOOD RD
Practice Address - Street 2:
Practice Address - City:CRITZ
Practice Address - State:VA
Practice Address - Zip Code:24082-3094
Practice Address - Country:US
Practice Address - Phone:276-288-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230038886183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician