Provider Demographics
NPI:1699175695
Name:CHILDERS, ASHLEY (PHARM D)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 WILLOW BECK LN
Mailing Address - Street 2:APT 305
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5080
Mailing Address - Country:US
Mailing Address - Phone:863-697-9697
Mailing Address - Fax:
Practice Address - Street 1:1010 53RD AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-4804
Practice Address - Country:US
Practice Address - Phone:863-697-9697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52427183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist