Provider Demographics
NPI:1841579844
Name:EZZELL, ASHLEY BARNES
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BARNES
Last Name:EZZELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 LIBERTY SQUARE
Mailing Address - Street 2:SUITE B
Mailing Address - City:KENANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28349
Mailing Address - Country:US
Mailing Address - Phone:910-296-0500
Mailing Address - Fax:910-296-0515
Practice Address - Street 1:134 LIBERTY SQUARE
Practice Address - Street 2:SUITE B
Practice Address - City:KENANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28349
Practice Address - Country:US
Practice Address - Phone:910-296-0500
Practice Address - Fax:910-296-0515
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist