Provider Demographics
NPI:1205316940
Name:ASHLEY, ALICE ANNETTE (RPH)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:ANNETTE
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3261 HIGHWAY 49
Mailing Address - Street 2:
Mailing Address - City:COLLINS
Mailing Address - State:MS
Mailing Address - Zip Code:39428-3876
Mailing Address - Country:US
Mailing Address - Phone:601-765-0519
Mailing Address - Fax:601-765-5045
Practice Address - Street 1:3261 HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:COLLINS
Practice Address - State:MS
Practice Address - Zip Code:39428-3876
Practice Address - Country:US
Practice Address - Phone:601-765-0519
Practice Address - Fax:601-765-5045
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-09014183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1982811642Medicaid