Provider Demographics
NPI:1649994302
Name:MOE, ASHLEY LYNN (PHARMD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LYNN
Last Name:MOE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 BLACKBIRD DR SW
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-3810
Mailing Address - Country:US
Mailing Address - Phone:515-291-2791
Mailing Address - Fax:
Practice Address - Street 1:1300 HIGHWAY 15 S
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-3801
Practice Address - Country:US
Practice Address - Phone:320-587-1023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125810183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN125810OtherMINNESOTA BOARD OF PHARMACY