Healthcare Provider Details

I. General information

NPI: 1629955968
Provider Name (Legal Business Name): ASHLEY BASTASIC PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 W NAVITUS DR
APPLETON WI
54913-9017
US

IV. Provider business mailing address

1025 W NAVITUS DR
APPLETON WI
54913-9017
US

V. Phone/Fax

Practice location:
  • Phone: 920-221-4177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15594-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: