Provider Demographics
NPI:1811380603
Name:BUILTA, ASHLEY LOUISE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LOUISE
Last Name:BUILTA
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 1:1298 BIELBY ST
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-1304
Mailing Address - Country:US
Mailing Address - Phone:248-821-0400
Mailing Address - Fax:
Practice Address - Street 1:408 KALAMAZOO PLZ
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48933-1919
Practice Address - Country:US
Practice Address - Phone:517-377-0240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302040206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist