Provider Demographics
NPI:1952811697
Name:ICE, ALEASHA X (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:ALEASHA
Middle Name:X
Last Name:ICE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7472 APACHE TRL
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-2507
Mailing Address - Country:US
Mailing Address - Phone:352-610-0327
Mailing Address - Fax:
Practice Address - Street 1:2201 N YOUNG BLVD
Practice Address - Street 2:
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-1957
Practice Address - Country:US
Practice Address - Phone:352-493-0775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSI35947390200000X
FLPS60818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program