Healthcare Provider Details

I. General information

NPI: 1740941152
Provider Name (Legal Business Name): ASHLEY MARIE WYNN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 E SOUTH BLVD
MONTGOMERY AL
36116-2409
US

IV. Provider business mailing address

1352 TULLAHOMA DR
PRATTVILLE AL
36066-2103
US

V. Phone/Fax

Practice location:
  • Phone: 334-286-2727
  • Fax:
Mailing address:
  • Phone: 205-516-7527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17413
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number17413
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: