Provider Demographics
NPI:1871276428
Name:BERRY, ASHLEY JEANETTE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JEANETTE
Last Name:BERRY
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 1:8089 LAPEER RD
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-2529
Mailing Address - Country:US
Mailing Address - Phone:810-658-5410
Mailing Address - Fax:
Practice Address - Street 1:8089 LAPEER RD
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-2529
Practice Address - Country:US
Practice Address - Phone:810-658-5410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302415242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315243585OtherCONTROLLED SUBSTANCE LICENSE