Provider Demographics
NPI:1922609304
Name:PITZER, ASHLEIGH DENSON
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:DENSON
Last Name:PITZER
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 1:6868 US HIGHWAY 129
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32060-8476
Mailing Address - Country:US
Mailing Address - Phone:386-330-2399
Mailing Address - Fax:386-364-1583
Practice Address - Street 1:6868 US HIGHWAY 129
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32060-8476
Practice Address - Country:US
Practice Address - Phone:386-330-2399
Practice Address - Fax:386-364-1583
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35829183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist