Provider Demographics
NPI:1902533177
Name:TEDESCO, ASHLEY LYNN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:LYNN
Last Name:TEDESCO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:ASHLEY
Other - Middle Name:LYNN
Other - Last Name:PECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11000 CREEDMOOR RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-9205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11000 CREEDMOOR RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-9205
Practice Address - Country:US
Practice Address - Phone:919-847-7786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-06
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31548183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist