Healthcare Provider Details

I. General information

NPI: 1619693686
Provider Name (Legal Business Name): ASHLI MILLER HEUSTESS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 10/12/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 US HIGHWAY 70 W
HAVELOCK NC
28532-9569
US

IV. Provider business mailing address

566 US HIGHWAY 70 W
HAVELOCK NC
28532-9569
US

V. Phone/Fax

Practice location:
  • Phone: 252-444-0885
  • Fax:
Mailing address:
  • Phone: 252-444-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number31755
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: