Provider Demographics
NPI:1700217478
Name:MEDINGER, ASHLEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:
Last Name:MEDINGER
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 1:2900 W OKLAHOMA AVE
Mailing Address - Street 2:OUTPATIENT PHARMACY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4330
Mailing Address - Country:US
Mailing Address - Phone:414-649-6930
Mailing Address - Fax:414-649-5367
Practice Address - Street 1:2900 W OKLAHOMA AVE
Practice Address - Street 2:OUTPATIENT PHARMACY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4330
Practice Address - Country:US
Practice Address - Phone:414-649-6930
Practice Address - Fax:414-649-5367
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16444-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist