Provider Demographics
NPI:1336627702
Name:TINNEY, ASHLEY
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:TINNEY
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 1:452 HARLOW DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2611
Mailing Address - Country:US
Mailing Address - Phone:910-489-2135
Mailing Address - Fax:
Practice Address - Street 1:138 OKATIE CENTER BLVD S
Practice Address - Street 2:
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-7546
Practice Address - Country:US
Practice Address - Phone:843-705-0999
Practice Address - Fax:843-705-6642
Is Sole Proprietor?:No
Enumeration Date:2018-07-29
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28140183500000X
SC42368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist