Provider Demographics
NPI:1952566598
Name:PRINCE, ASHLEY W
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:W
Last Name:PRINCE
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 1:914 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:SC
Mailing Address - Zip Code:29388-9023
Mailing Address - Country:US
Mailing Address - Phone:864-476-2800
Mailing Address - Fax:864-476-2880
Practice Address - Street 1:914 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:SC
Practice Address - Zip Code:29388-9023
Practice Address - Country:US
Practice Address - Phone:864-476-2800
Practice Address - Fax:864-476-2880
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12176183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist