1548749211 NPI number — ASHLEY BRYANT HOLCOMB PHARMD

Table of content: ASHLEY BRYANT HOLCOMB PHARMD (NPI 1548749211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548749211 NPI number — ASHLEY BRYANT HOLCOMB PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLCOMB
Provider First Name:
ASHLEY
Provider Middle Name:
BRYANT
Provider Name Prefix Text:
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548749211
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 410
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FYFFE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35971-0410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-638-6667
Provider Business Mailing Address Fax Number:
256-638-6658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1248 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FYFFE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35971-3471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-638-6667
Provider Business Practice Location Address Fax Number:
256-638-6658
Provider Enumeration Date:
08/13/2018

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:  17090 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100003112 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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