MEDICARE: ASHLEIGH CARMEN DUNNIVAN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	RPH035297	GA

General Provider Information

NPI Number	:	1053064394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEIGH CARMEN DUNNIVAN PHARMD

Provider Business Mailing Address
First Line	:	1639 BRADLEY PARK DR STE 600
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-3625
Country	:	US
Telephone Number	:	706-571-3426
Fax Number	:	706-571-3434

Provider Business Practice Location Address
First Line	:	1639 BRADLEY PARK DR STE 600
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-3625
Country	:	US
Telephone Number	:	706-571-3426
Fax Number	:	706-571-3434

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2022
Last Update Date	:	11/04/2025

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