Healthcare Provider Details

I. General information

NPI: 1306241237
Provider Name (Legal Business Name): ASHLEY CULLEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 LANCASTER DR NE
SALEM OR
97305-1348
US

IV. Provider business mailing address

5693 LANDON ST SE
SALEM OR
97306-2598
US

V. Phone/Fax

Practice location:
  • Phone: 503-378-7720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0013663
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: