Healthcare Provider Details

I. General information

NPI: 1972329886
Provider Name (Legal Business Name): MADISON ASHBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 UINTA WAY
PARK CITY UT
84098-1468
US

IV. Provider business mailing address

1725 UINTA WAY
PARK CITY UT
84098-1468
US

V. Phone/Fax

Practice location:
  • Phone: 435-649-7606
  • Fax:
Mailing address:
  • Phone: 435-649-7606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberN4796
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number11876047-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: