Provider Demographics
NPI:1972262889
Name:THUNDIYIL, ASHLEY XAVIER
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:XAVIER
Last Name:THUNDIYIL
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 1:16125 SE 260TH ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-8272
Mailing Address - Country:US
Mailing Address - Phone:714-350-1695
Mailing Address - Fax:
Practice Address - Street 1:117 SW 160TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3024
Practice Address - Country:US
Practice Address - Phone:206-242-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61176090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist