Provider Demographics
NPI:1457778029
Name:WALTON, ASHLEY MARY (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARY
Last Name:WALTON
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 E CONAN ST
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:MN
Mailing Address - Zip Code:55731-1436
Mailing Address - Country:US
Mailing Address - Phone:651-587-2118
Mailing Address - Fax:
Practice Address - Street 1:1500 E SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:MN
Practice Address - Zip Code:55731-1855
Practice Address - Country:US
Practice Address - Phone:218-365-7123
Practice Address - Fax:218-365-7124
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist