Provider Demographics
NPI:1063425387
Name:ASHLEY, ADRIAN G (RPH)
Entity type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:G
Last Name:ASHLEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-1971
Mailing Address - Country:US
Mailing Address - Phone:478-552-6111
Mailing Address - Fax:478-552-6113
Practice Address - Street 1:514 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-1971
Practice Address - Country:US
Practice Address - Phone:478-552-6111
Practice Address - Fax:478-552-6113
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH014104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist