Healthcare Provider Details

I. General information

NPI: 1124964549
Provider Name (Legal Business Name): ASHLEY KB HER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 IRVING AVE
SYRACUSE NY
13210-2716
US

IV. Provider business mailing address

4001 E GENESEE ST APT 108
SYRACUSE NY
13214-2150
US

V. Phone/Fax

Practice location:
  • Phone: 315-425-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number244090
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: