1962334896 NPI number — ANSLEY DIRST OGLESBY PHARMD

Table of content: ANSLEY DIRST OGLESBY PHARMD (NPI 1962334896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962334896 NPI number — ANSLEY DIRST OGLESBY PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OGLESBY
Provider First Name:
ANSLEY
Provider Middle Name:
DIRST
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:
1962334896
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
641 PARKER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYLVANIA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30467-5179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 REVOLUTIONARY TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29827-7109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-632-1951
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/03/2026

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:  RPH035216 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 67770 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 67770 . This is a "SOUTH CAROLINA BOARD OF PHARMACY" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: RPH035216 . This is a "GEORGIA BOARD OF PHARMACY" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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