Provider Demographics
NPI:1710237706
Name:JOHNSON, ASHLEIGH RUTH (PHARMACY INTERN)
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:RUTH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMACY INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20000 N 57TH AVE
Mailing Address - Street 2:APARTMENT H210
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6822
Mailing Address - Country:US
Mailing Address - Phone:262-909-9426
Mailing Address - Fax:
Practice Address - Street 1:20000 N 57TH AVE
Practice Address - Street 2:APARTMENT H210
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6822
Practice Address - Country:US
Practice Address - Phone:262-909-9426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZI009600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist