Healthcare Provider Details

I. General information

NPI: 1053917187
Provider Name (Legal Business Name): ASHLEY PATE JOHNSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 VILLAGE LN
WEDOWEE AL
36278-4585
US

IV. Provider business mailing address

146 VILLAGE LN
WEDOWEE AL
36278-4585
US

V. Phone/Fax

Practice location:
  • Phone: 256-357-4614
  • Fax: 256-357-4641
Mailing address:
  • Phone: 256-357-4614
  • Fax: 256-357-4641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14836
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: