Provider Demographics
NPI:1275415648
Name:ASHLEY, AMY CAROL
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CAROL
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:SEMINARY
Mailing Address - State:MS
Mailing Address - Zip Code:39479-0130
Mailing Address - Country:US
Mailing Address - Phone:601-722-3272
Mailing Address - Fax:601-722-3264
Practice Address - Street 1:PO BOX 130
Practice Address - Street 2:
Practice Address - City:SEMINARY
Practice Address - State:MS
Practice Address - Zip Code:39479-0130
Practice Address - Country:US
Practice Address - Phone:601-722-3272
Practice Address - Fax:601-722-3264
Is Sole Proprietor?:No
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-09874183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist