Provider Demographics
NPI:1316342017
Name:MACK, ASHLEY VICTORIA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:VICTORIA
Last Name:MACK
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 1:2040 ASHLEY RIVER RD
Mailing Address - Street 2:APT 907
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4715
Mailing Address - Country:US
Mailing Address - Phone:803-968-7978
Mailing Address - Fax:
Practice Address - Street 1:8523 OLD STATE RD
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:SC
Practice Address - Zip Code:29059
Practice Address - Country:US
Practice Address - Phone:803-496-3954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35845183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist