Healthcare Provider Details

I. General information

NPI: 1336023936
Provider Name (Legal Business Name): ASHLEY BORTLEIN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL DR
BENSON NC
27504-1177
US

IV. Provider business mailing address

5111 ISTRIAN WAY APT 207
RALEIGH NC
27610-7150
US

V. Phone/Fax

Practice location:
  • Phone: 919-207-1027
  • Fax:
Mailing address:
  • Phone: 812-209-8157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number34091
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: