Provider Demographics
NPI:1154971877
Name:COLBURN, ASHLEY SARA (PHARMD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:SARA
Last Name:COLBURN
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 1:612 SAINT JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1603
Mailing Address - Country:US
Mailing Address - Phone:269-471-5020
Mailing Address - Fax:
Practice Address - Street 1:612 SAINT JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-1603
Practice Address - Country:US
Practice Address - Phone:269-471-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-14
Last Update Date:2019-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist