MEDICARE: ASHLEY NOTTINGHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	S022078	AZ

General Provider Information

NPI Number	:	1548716798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY NOTTINGHAM

Provider Business Mailing Address
First Line	:	5210 S HIGHWAY 95
Second Line	:
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-9223
Country	:	US
Telephone Number	:	928-768-9022
Fax Number	:	928-788-3823

Provider Business Practice Location Address
First Line	:	5210 S HIGHWAY 95
Second Line	:
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-9223
Country	:	US
Telephone Number	:	928-768-9022
Fax Number	:	928-788-3823

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2016
Last Update Date	:	06/01/2022

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