Provider Demographics
NPI:1356946552
Name:DIEDRICH, ASHLEY (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:
Last Name:DIEDRICH
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 1:2680 LEONARD ST NE STE 5
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-6901
Mailing Address - Country:US
Mailing Address - Phone:616-224-1121
Mailing Address - Fax:616-224-3001
Practice Address - Street 1:2680 LEONARD ST NE STE 5
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-6901
Practice Address - Country:US
Practice Address - Phone:616-224-1121
Practice Address - Fax:616-224-3001
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist