Provider Demographics
NPI:1639508765
Name:ASHE, SAM
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:ASHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 NUCLEUS AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59912-4007
Mailing Address - Country:US
Mailing Address - Phone:406-892-9088
Mailing Address - Fax:406-892-9087
Practice Address - Street 1:419 NUCLEUS AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA FALLS
Practice Address - State:MT
Practice Address - Zip Code:59912-4007
Practice Address - Country:US
Practice Address - Phone:406-892-9088
Practice Address - Fax:406-892-9087
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist