Healthcare Provider Details

I. General information

NPI: 1508452632
Provider Name (Legal Business Name): ASHLEY LEACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2020
Last Update Date: 12/13/2020
Certification Date: 12/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 E GERMAN LN
CONWAY AR
72032-4555
US

IV. Provider business mailing address

5 SAMANTHA CIR
SEARCY AR
72143-5035
US

V. Phone/Fax

Practice location:
  • Phone: 501-329-3733
  • Fax:
Mailing address:
  • Phone: 501-590-4587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD14518
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: