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General NPI Number Information
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NPI Number | 1316260490
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Entity Type | Individual
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Provider Name | MARY KATHLEEN ASHLOCK RPH
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Gender | Female
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Dates
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Enumeration Date | 03/03/2010
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Last Update Date | 03/03/2010
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Provider Practice Location Address
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Address Line | 5590 MABLETON PKWY SW STE 100
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City | MABLETON
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State | GA
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Zip | 30126-3342
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Country | US
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Telephone | 770-745-5635
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Fax | 770-745-7121
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Provider Business Mailing Address
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Address Line | 246 ORMOND ST SE
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City | ATLANTA
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State | GA
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Zip | 30315-1357
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Country | US
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Telephone | 404-287-2518
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Fax | 770-745-7121
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 16718
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License Number State | GA
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