Provider Demographics
NPI:1104491141
Name:MEYETTE, ASHLEE (CPHT)
Entity type:Individual
Prefix:
First Name:ASHLEE
Middle Name:
Last Name:MEYETTE
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 JOE MANN BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-8903
Mailing Address - Country:US
Mailing Address - Phone:989-835-6364
Mailing Address - Fax:
Practice Address - Street 1:910 JOE MANN BLVD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-8903
Practice Address - Country:US
Practice Address - Phone:989-835-6364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303030410183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician