Provider Demographics
NPI:1154712909
Name:UPSHAW, ASHLEY (PHARMD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:UPSHAW
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-8913
Mailing Address - Country:US
Mailing Address - Phone:912-537-4147
Mailing Address - Fax:912-537-1014
Practice Address - Street 1:1704 MEADOWS LN
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-8913
Practice Address - Country:US
Practice Address - Phone:912-537-4147
Practice Address - Fax:912-537-1014
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH028286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist