Provider Demographics
NPI:1396320768
Name:HUBBARD, AMBRIANA SIMONE (PHARMD)
Entity type:Individual
Prefix:
First Name:AMBRIANA
Middle Name:SIMONE
Last Name:HUBBARD
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 1:5801 HEARTHWOOD CT APT B
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-1241
Mailing Address - Country:US
Mailing Address - Phone:843-337-9208
Mailing Address - Fax:
Practice Address - Street 1:3634 REYNOLDA RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-2230
Practice Address - Country:US
Practice Address - Phone:336-923-2367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC30266OtherNC PHARMACIST LICENSE