Provider Demographics
NPI:1194108902
Name:ASHLAND PHARMACY LLC
Entity type:Organization
Organization Name:ASHLAND PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-258-7922
Mailing Address - Street 1:PO BOX 412
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:38603-0412
Mailing Address - Country:US
Mailing Address - Phone:901-258-7922
Mailing Address - Fax:
Practice Address - Street 1:16068 BOUNDARY DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MS
Practice Address - Zip Code:38603-7737
Practice Address - Country:US
Practice Address - Phone:901-258-7922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy