Healthcare Provider Details

I. General information

NPI: 1891186136
Provider Name (Legal Business Name): ASHLEY MUSCHA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 32ND AVE S
FARGO ND
58103-5800
US

IV. Provider business mailing address

2633 2ND ST E
WEST FARGO ND
58078-7985
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-9912
  • Fax: 701-297-0807
Mailing address:
  • Phone: 701-730-5573
  • Fax: 701-297-0807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH5237
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: