Provider Demographics
NPI:1639998487
Name:FRAIS, ASHLEY ROLLIN (PHARMD, MBA)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:ROLLIN
Last Name:FRAIS
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23035 BAY AVE APT 189
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-9617
Mailing Address - Country:US
Mailing Address - Phone:786-657-6586
Mailing Address - Fax:
Practice Address - Street 1:425 W RIDER ST STE B2
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-3230
Practice Address - Country:US
Practice Address - Phone:951-943-6303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA89848OtherCALIFORNIA BOARD OF PHARMACY