MEDICARE: MR. MIKEL SCOTT ASHBY RPH

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	183500000X	Pharmacist	14672	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	154036-1701	OTHER	UT	UTAH STATE BOARD OF PHARMACY
2	14673	OTHER	NV	NEVADA STATE BOARD OF PHARMACY

General Provider Information

NPI Number	:	1962835629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MIKEL SCOTT ASHBY RPH

Provider Business Mailing Address
First Line	:	212 ELKS POINT RD
Second Line	:	PO BOX 11111
City	:	ZEPHYR COVE
State	:	NV
Zip	:	89448-8001
Country	:	US
Telephone Number	:	775-586-1088
Fax Number	:	775-586-9019

Provider Business Practice Location Address
First Line	:	212 ELKS POINT RD
Second Line	:
City	:	ZEPHYR COVE
State	:	NV
Zip	:	89448-8001
Country	:	US
Telephone Number	:	775-586-1088
Fax Number	:	775-586-9019

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

Provider Enumeration Date	:	08/16/2013
Last Update Date	:	08/16/2013

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