1730304601 NPI number — DR. ASHLEE SUZANN COLVIN PHARMD

Table of content: AMY A HARDY (NPI 1154459436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730304601 NPI number — DR. ASHLEE SUZANN COLVIN PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLVIN
Provider First Name:
ASHLEE
Provider Middle Name:
SUZANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLVIN
Provider Other First Name:
ASHLEE
Provider Other Middle Name:
SUZANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARM.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1730304601
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3809 BANYAN GROVE LN
Provider Second Line Business Mailing Address:
APT 307
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23462-7471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-454-3434
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3809 BANYAN GROVE LN
Provider Second Line Business Practice Location Address:
APT 307
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23462-7471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-454-3434
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PS40686 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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