Provider Demographics
NPI:1366093320
Name:ANTHONY, ASHLEY
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DEEP RIVER
Mailing Address - State:CT
Mailing Address - Zip Code:06417-2039
Mailing Address - Country:US
Mailing Address - Phone:860-526-8052
Mailing Address - Fax:
Practice Address - Street 1:180 MAIN ST
Practice Address - Street 2:
Practice Address - City:DEEP RIVER
Practice Address - State:CT
Practice Address - Zip Code:06417-2039
Practice Address - Country:US
Practice Address - Phone:860-526-8052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-21
Last Update Date:2019-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0013696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist