=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780544940
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEY GREEN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2025
-----------------------------------------------------
Last Update Date | 11/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 920 BELL AVE
-----------------------------------------------------
City | WESTBROOK
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56183-9669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-274-1092
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 251 WASHINGTON AVE N
-----------------------------------------------------
City | BALATON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56115-1084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P2201X
-----------------------------------------------------
Taxonomy Name | Ambulatory Care Pharmacist
-----------------------------------------------------
License Number | 126207
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------