Healthcare Provider Details

I. General information

NPI: 1497357040
Provider Name (Legal Business Name): ASHLEY HAZLETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 CLARION RD
ALTAVISTA VA
24517-1164
US

IV. Provider business mailing address

370 WALTON DR
APPOMATTOX VA
24522-4137
US

V. Phone/Fax

Practice location:
  • Phone: 434-309-2680
  • Fax:
Mailing address:
  • Phone: 434-238-2607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202215222
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: