Healthcare Provider Details

I. General information

NPI: 1467751693
Provider Name (Legal Business Name): ASHLEY SHERWOOD LONDON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 WASHINGTON RD
MARTINEZ GA
30907
US

IV. Provider business mailing address

2604 PEACH ORCHARD RD
AUGUSTA GA
30906-2489
US

V. Phone/Fax

Practice location:
  • Phone: 706-868-8084
  • Fax: 706-868-8059
Mailing address:
  • Phone: 706-798-5645
  • Fax: 706-798-0377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number024883
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: