Healthcare Provider Details

I. General information

NPI: 1346534435
Provider Name (Legal Business Name): ASHLEY BLANCH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 OVERTON RIDGE BLVD T1770
FORT WORTH TX
76132-3220
US

IV. Provider business mailing address

5700 OVERTON RIDGE BLVD T1770
FORT WORTH TX
76132-3220
US

V. Phone/Fax

Practice location:
  • Phone: 817-423-1661
  • Fax: 817-423-1661
Mailing address:
  • Phone: 817-423-1661
  • Fax: 817-423-1661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number49211
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: