Provider Demographics
NPI:1104582352
Name:FALLEN, ASHLEY MICHELLE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MICHELLE
Last Name:FALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:MICHELLE
Other - Last Name:FALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD,RPH
Mailing Address - Street 1:683 BURDEN AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-5940
Mailing Address - Country:US
Mailing Address - Phone:518-210-5213
Mailing Address - Fax:
Practice Address - Street 1:724 UPPER GLEN ST
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-2019
Practice Address - Country:US
Practice Address - Phone:518-210-5213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1068504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist