Provider Demographics
NPI:1205113974
Name:PHAM, ASHLEY (PHARM D)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6636 N 73RD PLZ
Mailing Address - Street 2:T-2010
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-1803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6636 N 73RD PLZ
Practice Address - Street 2:T-2010
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1803
Practice Address - Country:US
Practice Address - Phone:402-573-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist